ubstance abuse is a major public health problem that puts millions of adolescents at increased risk for alcohol-related and drug-related traffic accidents, risky sexual practices, poor academic performance, juvenile delinquency, and developmental problems. Although several national surveys indicate that teen use of most illicit drugs has held steady during the past few years, adolescent drug abuse remains alarmingly high. Moreover, use of the dangerous club drug MDMA (Ecstasy) appears to be increasing among older teens. Below are important facts to know about substance abuse, addiction, treatment, and recovery among adolescents.

Substance Abuse and Adolescents

• Alcohol and Illicit Drug Use
  Among youth age 12 to 17, an estimated 1.1 million meet the diagnostic criteria for dependence on illicit drugs, and 915,000 are dependent on alcohol.¹

  More than half (55 percent) of our nation’s 12th graders have tried an illicit drug, and more than one-quarter (29 percent) have tried a drug other than marijuana, such as cocaine, inhalants, and heroin.²

Youth age 16 to 17 have the second highest rate (16.4 percent) of current illicit drug use in the country. The highest rate (19.9 percent) is found among young people age 18 to 20.¹

Although consumption of alcoholic beverages is illegal for people under 21 years of age, 10.4 million current drinkers are age 12 to 20. Of this group, nearly half (5.1 million) engage in binge drinking, including 2.3 million who would also be classified as heavy drinkers.¹

About one-quarter of youth age 10 to 17 say their friends "huff" (inhale the fumes of household products such as glue and paint), and more than one-third (34 percent) of these youth are between age 13 and 15 when they are first exposed to peers who use inhalants.³

In 1998, nearly 10 percent of adolescents (age 12 to 17) reported using an illicit drug at least once during the past month. About 1 in 12 youth (8.3 percent) in this age group are current (past month) users of marijuana, the most frequently used illicit drug, and 19.1 percent are current users of alcohol.¹

• Attitudes Toward Alcohol and Illicit Drug Use
  About half (54 percent) of youth age 12 to 17 perceive a great risk in smoking marijuana once or twice a week or using cocaine once a month.¹

Among 12th graders, less than two-thirds (62.5 percent) disapprove or strongly disapprove of smoking marijuana occasionally.⁴

Among adolescents age 12 to 17, less than half (47 percent) perceive a great risk in having five or more drinks once or twice a week; two-thirds (66.4) perceive such risk in having four or five drinks nearly every day.¹

About 40 percent of teens age 13 to 18 strongly agree that "really cool" teens do not use drugs.⁵

Nearly one in four teens age 12 to 17 cite drugs as the most important problem facing people their age.⁶

• Availability of Alcohol and Illicit Drugs
  In 1998, 56 percent of youth age 12 to 17 reported that marijuana is easy or fairly easy to obtain. Other illicit drugs that are perceived as easy or fairly easy to obtain include cocaine (reported by 30 percent of these youth), crack (29 percent), and heroin (21 percent).¹

In 1999, alcohol was reported fairly easy or very easy to get by 72.3 percent of 8th graders and 88.2 percent of 10th graders.⁷

Nearly 14 percent of youth age 12 to 17 reported being approached by someone selling illicit drugs during the 30 days prior to their interview for a 1998 survey.¹

By the time they reach age 17, more than half (56 percent) of adolescents know a drug dealer.⁶

Addiction as a Medical Disorder

• Addiction is a chronic disease involving a number of brain chemistry disorders.⁸

• Children of substance abusing parents are at increased risk for substance abuse and related problems because of both genetic and environmental factors.^{9, 10}

• Changes in brain chemistry over time make it difficult for persons with addictive disorders to stop using drugs or alcohol despite their wish to do so.⁸ Lapses in the prescribed treatment therapy also can interfere with a person’s ability to stop using drugs or alcohol.

• Addiction treatment is as effective as treatments for other chronic medical conditions such as diabetes and hypertension.¹¹

• Recovery from addiction is dependent on the availability of treatment and may require multiple courses of treatment as with other relapsing conditions.⁹

Consequences of Adolescent Substance Abuse

Adolescents face unique risks associated with substance abuse. The use of substances may compromise an adolescent’s mental and emotional development by interfering with how young people approach and experience interactions.¹² In addition, adolescents are at serious risk for a number of direct and indirect consequences, including the following:

• Traffic Accidents—Nearly half (45 percent) of all deaths from traffic accidents are related to the consumption of alcohol, and an estimated 18 percent of drivers age 16 to 20 (or 2.5 million adolescents) drive under the influence of alcohol.¹²

• School-Related Problems—Adolescent substance abuse is associated with declining grades, absenteeism from school, and dropping out of school. Cognitive and behavioral problems experienced by teens abusing substances may interfere with their academic performance.¹³

• Risky Sexual Practices—Adolescents who use drugs and alcohol are more likely than nonusing teens to have sex, initiate sex at a younger age, and have multiple sex partners, placing them at greater risk for unplanned pregnancies and HIV/ AIDS, hepatitis C, and other sexually transmitted diseases.¹⁴

• Delinquent Behavior—Adolescents who use marijuana weekly are six times more likely than nonusers to report they run away from home, five times more likely to say they steal from places other than home, and four times more likely to report they physically attack people.¹⁵

• Juvenile Crime—Adolescents age 12 to 16 who have ever used marijuana are more likely at some point to have sold marijuana (24 percent vs. less than 1 percent), carried a handgun (21 percent vs. 7 percent), or been in a gang (14 percent vs. 2 percent) than youth who have never used marijuana.¹⁶

• Developmental Problems—Substance abuse can compromise an adolescent’s psychological and social development in areas such as the formation of a strong self-identity, emotional and intellectual growth, establishment of a career, and the development of rewarding personal relationships.¹²

• Physical and Mental Consequences—Smoking marijuana can have negative effects on the user’s mind and body. It can impair short-term memory and comprehension, alter one’s sense of time, and reduce the ability to perform tasks that require concentration and coordination, such as driving a car. Evidence also suggests that the long-term effects of using marijuana may include increased risk of lung cancer and other chronic lung disorders, head and neck cancer, sterility in men, and infertility in women.^{17, 18}

• Future Use Disorders—The earlier the age at which a person first drinks alcohol, the more likely that person is to develop an alcohol use disorder. A person who starts drinking alcohol at age 13 is four times more likely to develop alcohol dependence at some time in his or her life than someone who starts drinking at age 20.¹⁹

Signs and Symptoms of Substance Abuse

People who interact with adolescents in the home or community need to be alert to changes in an adolescent’s behavior and appearance that may signal substance abuse. By recognizing the potential warning signs and symptoms of substance use, you may be able to get help for a teenager in need of treatment. The following behavior changes, when extreme or lasting for more than a few days, may indicate alcohol-related or drug-related problems and the need for further screening by a professional.

• Sudden changes in personality without another known cause
• Loss of interest in once favorite hobbies, sports, or other activities
• Sudden decline in performance or attendance at school or work
• Changes in friends and reluctance to talk about new friends
• Deterioration of personal grooming habits
• Difficulty in paying attention, forgetfulness
• Sudden aggressive behavior, irritability, nervousness, or giddiness
• Increased secretiveness, heightened sensitivity to inquiry

Screening and Assessment of Adolescent Substance Abuse

• Screening for adolescent substance abuse should be conducted by health care delivery systems, juvenile justice and family court systems, and community organizations such as schools, vocational rehabilitation, and religious organizations.²⁰

• Adolescents who should be screened for substance abuse include all teens who receive mental health assessments, enter the child welfare system, drop out of school, or stay at homeless shelters. Adolescents arrested or detained within the juvenile justice and family court systems also should be screened.²⁰

• Screening for substance abuse should focus on the adolescent’s severity of use and core associated factors such as mental health status, family history of parental addiction, functioning in school, and any legal problems.²⁰

• Referral to a comprehensive assessment should be made for all adolescents whose screening reveals indicators (e.g., daily use of one or more substances) of serious substance abuse problems.²⁰

Treatment of Adolescent Substance Abuse

• Admissions to substance abuse treatment programs for persons age 17 or younger increased to 8.9 percent of all admissions in 1997. Persons age 19 and younger accounted for more than 49 percent of all admissions for marijuana use and dependence.²¹

• Among youth age 12 to 17, an estimated 175,000 have received treatment or counseling for their drug use, and 148,000 have received treatment or counseling for alcohol use.¹

• A significant gap exists between the number of adolescents who need substance abuse treatment and those who receive it. According to a study in Minnesota, only one-fourth of youth age 14 to 17 who need substance abuse treatment received it.²²

• Substance abuse treatment is effective for adolescents. A national study of community-based treatment programs for adolescents found that reported weekly marijuana use dropped by more than half in the year following treatment. Clients also reported less heavy drinking, less use of hard drugs, and less criminal involvement. Other benefits included better psychological adjustment and improved school performance after treatment.²³

Special Considerations for Adolescent Treatment

Treating adolescents for substance abuse requires special consideration of the adolescent’s individual experience and how it affects the nature and severity of his or her alcohol or drug use. Understanding the adolescent’s situation will help explain why alcohol or drugs are used and how they became an integral part of his or her identity.

Factors that need to be considered when tailoring treatment for adolescents include the following:

• Developmental Stages—Treatment for adolescents must address their unique developmental needs, which vary with the age of the client. Developmental features of younger adolescents are different from those of older adolescents. For example, older adolescents are more capable of abstract thinking and are more likely to openly rebel than younger adolescents.¹²

• Ethnicity and Culture—Norms, values, and health beliefs differ across cultures and can affect substance abuse treatment. For example, some cultural groups may consider treatment invasive; others may wish to involve the extended family. Treatment services need to be culturally competent and use the preferred language of adolescent clients and their families.¹²

• Gender and Sexual Orientation—Factors that influence adolescent substance abuse and involvement in treatment differ by gender. For example, whereas adolescent girls more often have internalizing coexisting disorders such as depression, boys are more likely to have externalizing disorders such as conduct disorders. Effective treatment for gay, bisexual, and transgendered youth includes helping them to acknowledge and accept their sexual identity.¹²

• Coexisting Mental Disorders—Adolescents with substance abuse disorders are more likely than their abstinent peers to have coexisting mental health problems such as anxiety disorders, attention deficit-hyperactivity disorder, and depression. In these teens, substance abuse may disguise, exacerbate, or be used to "self medicate" psychiatric symptoms. Without tailored treatment, coexisting mental disorders could interfere with the adolescent’s ability and motivation to participate in addiction treatment and could increase the potential for relapse.^{12, 24, 25}

• Family Factors—An adolescent’s family has a potential role both in the origin of his or her substance abuse problem and as an agent of change in the adolescent’s environment. Treatment should take into account family factors that increase risk for substance abuse problems in youth, such as any history of parental or sibling substance abuse problems or addiction; domestic violence; physical, sexual, or emotional abuse, and neglect. Whenever possible, parents should be involved in all phases of their adolescent’s treatment.¹²

Identification of Community Resources

There are a number of ways to find out about substance abuse treatment programs in your area. Contact these sources of referral information.

• Your school district’s nursing staff, psychologist, social worker, or substance abuse coordinator or counselor may be able to identify local treatment programs. Other possible sources of referral information include your doctor, local hospital, pastor or clergy, and county mental health society.

• Public and private agencies, such as local health departments, state alcohol and drug authorities, and state and local professional societies may compile directories that can help you locate treatment programs. These directories may offer information on the types of facility settings and care provided as well as special services for adolescents.

• The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes the National Directory of Drug Abuse and Alcoholism Treatment Programs, which lists Federal, state, local, and private facilities that provide treatment services. The directory can be ordered from SAMHSA’s National Clearinghouse on Alcohol and Drug Information at 800-729-6686 and is available online with search and browse capabilities at SAMHSA’s Web site (www.samhsa.gov).

• SAMHSA’s Center for Substance Abuse Treatment supports a National Helpline at 800-662-HELP (800-662-4357). Through this toll-free, confidential service, trained specialists provide information on substance abuse and available treatment options. They also provide referrals nationwide to treatment programs, self-help and family support groups, and crisis centers.

Ways to Support Adolescents in Treatment and Recovery

Adolescents who are in treatment or recovery need all the support they can get from their families and communities. Consider taking one or more of the following actions to support youth undergoing treatment for and recovery from substance abuse.

• Encourage schools to offer student assistance programs, counseling on substance abuse, and confidential referral to treatment and recovery resources in the community.

• Encourage purchasers of health insurance to obtain comprehensive coverage for substance abuse and mental health services.

• Encourage treatment centers, schools, and community-based youth organizations to conduct support groups for children of parents who are addicted to alcohol and drugs.

• Encourage adolescents who have recovered successfully from addictive disorders to participate in community events that target their peers.

• Because alcohol and drug use among youth often occurs in groups, be aware that encouraging one young person to seek help may lead others in his or her social group to seek treatment.

• Encourage environmental changes in your community that promote recovery such as reducing the number of billboards advertising alcoholic beverages and holding alcohol-free recreational events.

• Encourage the participation of family members in all aspects of the treatment and recovery process for adolescents, and foster the availability of family-centered support groups and other services that address the needs of the entire family.

• Be a positive role model for young people in treatment and recovery by not engaging in any illegal or unhealthy substance use.

• Get involved in organizations that advocate public policies and funding to support substance abuse treatment and recovery programs for adolescents.

• Stay informed about available local resources for treatment and recovery and use this knowledge to help others.

Sources

¹ Summary of Findings from the 1998 National Household Survey on Drug Abuse. DHHS Publication No. (SMA) 99-3328. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 1999.

² Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and 12th Graders. Table 1a: Trends in Lifetime Prevalence of Use of Various Drugs for 8th, 10th, and 12th Graders, 1991-1999. Ann Arbor, MI: Survey Research Center, Institute for Social Research, University of Michigan, 1999. URL: www.monitoringthefuture.org/data/99data.html#1999data-drugs (Accessed December 20, 1999.)

³ American Academy of Pediatrics (AAP). Releases New Findings on Inhalant Abuse (Press Release), September 30, 1999.

⁴ Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and 12th Graders. Table 8: Trends in Disapproval of Drug Use by 8th, 10th, and 12th Graders, 1991-1999. Ann Arbor, MI: Survey Research Center, Institute for Social Research, University of Michigan, 1999. URL: www.monitoringthefuture.org/data/99data.html#1999data-drugs (Accessed December 20, 1999.)

⁵ Partnership for a Drug-Free America (PDFA). 1999 Partnership Attitude Tracking Study. New York, NY: PDFA, 1999.

⁶ National Center on Addiction and Substance Abuse at Columbia University. Back to School—National Survey of American Attitudes on Substance Abuse V: Teens and Their Parents. New York, NY: National Center on Addiction and Substance Abuse at Columbia University, 1999.

⁷ Monitoring the Future. 1999 Data from In-School Surveys of 8th, 10th, and 12th Graders. Table 10: Trends in Perceived Availability of Drugs for 8th, 10th, and 12th Graders, 1991-1999. Ann Arbor, MI: Survey Research Center, Institute for Social Research, University of Michigan, 1999. URL: www.monitoringthefuture.org/data/99data.html#1999data-drugs (Accessed December 20, 1999.)

⁸ Center for Substance Abuse Treatment. "The Science of Addiction: Simplified," Substance Abuse in Brief. Rockville, MD: Substance Abuse and Mental Health Services Administration, July 1999.

⁹ Anthenelli, R.M., Schuckit, M.A. Genetic Studies of Alcoholism. International Journal of Addiction, 25:81-94, 1990.

¹⁰ Merkiangas, K.R., Stolar, M., Stevens, D.E., et al. Familial Transmission of Substance Use Disorders. Archives of General Psychiatry, 55:973-979, 1998.

¹¹ National Institute on Drug Abuse (NIDA). Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 99-4180. Rockville, MD: NIDA, National Institutes of Health, October 1999.

¹² Center for Substance Abuse Treatment. Treatment of Adolescents With Substance Abuse Problems. Treatment Improvement Protocol (TIP) Series, No. 32. DHHS Publication No. (SMA) 99-3283. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

¹³ Crowe, A.H. Drug Identification and Testing in the Juvenile Justice System: Summary. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, 1998.

¹⁴ National Center on Addiction and Substance Abuse at Columbia University. Dangerous Liaisons: Substance Abuse and Sex. New York, NY: National Center on Addiction and Substance Abuse at Columbia University, 1999.

¹⁵ Greenblatt, J.C. Adolescent Self-Reported Behaviors and Their Association with Marijuana Use. In: Analyses of Substance Abuse and Treatment Need Issues. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

¹⁶ Synder, H.N., Sickmund, M. Juvenile Offenders and Victims: 1999 National Report. Washington, DC: National Center for Juvenile Justice, 1999.

¹⁷ Zhang, Z.F., Morgenstern, H., Spitz, M.R., et al. Marijuana Use and Increased Risk of Squamous Cell Carcinoma of the Head and Neck. Cancer Epidemiology, Biomarkers, and Prevention 8(12):1071-1078, December 1999.

¹⁸ Center for Substance Abuse Prevention. Tips for Teens About Marijuana. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1998.

¹⁹ Grant, B.F., Dawson, D.A. Age at Onset of Alcohol Use and its Association with DSM-IV Alcohol Abuse and Dependence. Journal of Substance Abuse 9:103-110, 1997.

²⁰ Center for Substance Abuse Treatment. Screening and Assessing Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 31. DHHS Publication No. (SMA) 99-3282. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

²¹ Office of Applied Studies. National Admissions to Substance Abuse Treatment Services: The Treatment Episode Data Set (TEDS) 1992-1997. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

²² Minnesota Department of Human Services. Estimate of the Need for Alcohol/Drug-Related Services for Adolescents in Minnesota: Implications for Managed Care Organizations and Health Care Providers. St. Paul, MN: Minnesota Department of Human Services, Performance Measurement and Quality Improvement Division, 1997.

²³ Hser, Y-I., Grella, C., Hsieh, S-C., Anglin, M.D. National Evaluation of Drug Treatment for Adolescents. Presented at the College on Problems of Drug Dependence Annual Meeting, June 1999. URL: http://www.datos.org/posters/CPDD_99_Hser/index.htm (Accessed December 21, 1999.)

²⁴ Center for Substance Abuse Treatment. Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Use. Treatment Improvement Protocol (TIP) Series, No. 9. DHHS Publication No. (SMA) 95-3061. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1995.

²⁵ Winters, K.C. Treating Adolescents with Substance Use Disorders: An Overview of Practice Issues and Treatment Outcome. Substance Abuse 20(4):203-225, 1999.

A Call to Action

eople in the United States can gain access to substance abuse treatment in a wide variety of ways, such as private health insurance, Medicare, Medicaid, and other public sector health programs. However, meeting the complex health and social needs of young people with substance abuse problems still presents a formidable challenge for policymakers and health insurers. While adolescents with substance abuse problems require a diverse range of special services, there is a dramatic shortage of appropriate treatment models for adolescents. Most treatment programs simply adapt adult models to adolescent needs, which often results in inappropriate care. Consider these facts:

• When properly designed and administered, managed care can provide high-quality care and reduce costs at the same time. However, without careful attention, managed care can result in undertreatment and neglect of some of the nation’s most vulnerable citizens,¹ including adolescents with substance abuse problems.

• A quality system of care for adolescents with substance abuse problems includes a range of services that are tailored to the unique needs of adolescents, including prevention services, assessment and referral services, psychological psychotherapeutic services, pharmacological treatment, and case management and "wraparound" services.²

• While proponents of managed care point to a decline in inappropriate inpatient placements, some critics say that adolescents with severe substance abuse problems are not getting the intensive care they need. There is also increasing evidence that adolescents receiving inpatient care are being discharged too soon—before their condition is stabilized and before the community support services they need are in place.³

• States that finance and manage behavioral health services for youth separately from physical health care services ("carve out") tend to offer adolescents and their families more flexibility, a broader range of services, and a stronger emphasis on home-based and community-based services. In states that finance and manage integrated behavioral and physical health care services ("carve in"), adolescents tend to receive less substance abuse coverage.³

• Medical costs are higher for patients with untreated substance abuse problems, and there is significant evidence that the provision of comprehensive behavioral health services offsets the cost of some unnecessary or ineffective medical treatments.⁴

• More and more states are recognizing the importance of involving family members of children with substance abuse problems in designing health benefit plans and participating as advisors and evaluators.³

Getting Involved—Next Steps

Policy makers and health insurers can play an important role in ensuring that managed care not only reduces costs and increases access, but also promotes high-quality care that meets the unique needs of each person. For adolescents with substance abuse problems and their families, "high-quality" care should be defined as ensuring that adolescents and families receive the full range of services and support they need for as long as they need them. Here are some steps you can take to make this vision a reality:

• Regardless of how treatment services are financed and delivered, vigorously support the development of comprehensive systems of care for adolescents with substance abuse problems. These systems should be composed of such agencies as substance abuse, mental health, primary health, education, and juvenile justice and family court programs that work together to meet the treatment and support needs of both the adolescent and his or her family. This is especially important in families with a history of addiction.

• Ensure that treatment programs provide adolescents and families with individualized service plans tailored to their unique needs. Remember that "one size does not fit all."

• Ensure that each adolescent with a substance abuse problem has access to a full array of services and support in the community in which he or she lives.

• Encourage agencies and programs that serve adolescents and families to establish formal linkages to ensure that the system of care is adequately coordinated and integrated—even if these agencies and programs are funded by different financing streams.

• Promote the development of case management services that include a full range of options to safeguard adolescents as they move through the system and their needs change.

• Emphasize early identification and intervention of substance abuse problems among youth.

• Ensure that all services are delivered in a way that is consistent with, and responsive to, the family’s language and culture.

• Learn more about successful managed care models of substance abuse treatment for adolescents that are based on system-of-care principles.

• Educate other health care policymakers and insurers about the need to provide coverage for substance abuse treatment equal to that for medical care.

• Hold community forums, public policy panels, and town hall meetings to initiate a dialog with members of the business sector, substance abuse treatment providers, the faith community, the media, and family members of adolescents with substance abuse problems. Get their ideas on how to improve substance abuse treatment services in the community, city or town, or state.

• Involve adolescents and young adults with a past history of addiction in briefing state and community leaders. Ask these young people to describe the challenges they faced when addictive disorders went untreated, and the need for comprehensive treatment and support systems.

• Issue proclamations in support of adolescent treatment for substance abuse problems, particularly during National Alcohol and Drug Abuse Recovery Month in September. These proclamations can be made by state and local governments, professional organizations, and other groups. Also, participate in State House or City Hall Recovery Day celebrations to honor individuals in recovery.

• Assume a leadership role in educating the public about the link between substance abuse problems among youth and violence; loitering; teen pregnancy; HIV and hepatitis C transmission; school dropouts and school failure; job absenteeism; traffic crashes and fatalities; fires; vandalism; suicide; homicide, illness, and disease; and increased health care costs.

Additional Resources for Health Policymakers and Insurers

American Managed Behavioral Healthcare Association
700 13th Street, NW, Suite 950
Washington DC, 20005
202-434-4565
www.ambha.org

American Public Health Association
800 I Street, NW
Washington, DC 20001-3710
202-777-2742
202-777-2500 (TTY)
www.apha.org

Families USA
1334 G Street, NW
Washington, DC 20005
202-628-3030
www.familiesusa.org

Join Together
441 Stuart Street, 7th Floor
Boston, MA 02116
617-437-1500
www.jointogether.org

National Association of Alcoholism and Drug Abuse Counselors
1911 North Fort Myer Drive, Suite 900
Arlington, VA 22209
800-548-0497
www.naadac.org

National Association of State Alcohol and Drug Abuse Directors
808 17th Street, NW, Suite 410
Washington, DC 20006
202-293-0090
www.nasadad.org

National Committee for Quality Assurance
2000 L Street, NW, Suite 500
Washington, DC 20036
202-955-3500
www.ncqa.org

National Council on Alcoholism and Drug Dependence, Inc.
12 West 21st Street
New York, NY 10010
212-206-6770
800-NCA-CALL (Hopeline)
www.ncadd.org

National Health Law Program
Health Consumer Alliance
225 Bush Street, Suite 755
San Francisco, CA 94104
415-732-5750
www.healthlaw.org

National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard
Willco Building
Bethesda, MD 20892-7003
301-496-4000
www.niaaa.nih.gov

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
703-684-7722
800-433-5959 (TTY)
www.nmha.org

Open Minds
10 York Street, Suite 200
Gettysburg, PA 17325
717-334-1329
877-350-6463
www.openminds.com

Physician Leadership for National Drug Policy
Center for Alcohol and Addiction Studies
Brown University
Box G-BH
Providence, RI 02912
401-444-1817
http://caas.caas.biomed.brown.edu/plndp

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
National Helpline
800-662-HELP (800-662-4357)
(for confidential information on substance abuse treatment and referral)

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686 (for information)
ncadi.samhsa.gov

Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Knowledge Exchange Network
P.O. Box 42490
Washington, DC 20015
800-789-2647
www.mentalhealth.samhsa.gov/CMHS

Sources

¹ Institute of Medicine. Managing Managed Care: Quality Improvement in Behavioral Health, Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care, 1997.

² Minugh, P.A., Cotter, F., Jackson, J. Treatment Improvement Exchange Communiqué. Quality Services for Adolescents with Substance Abuse Prevention and Treatment Needs: A Brief Review. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Fall 1999.

³ Stroul B.A., Pires, S.A., Armstrong, M.I. Health Care Reform Tracking Project: Tracking State Managed Care Reforms As They Affect Children and Adolescents With Behavioral Health Disorders and Their Families—1997 Impact Analysis. Tampa, FL: Research and Training Center for Children’s Mental Health, Department of Child and Family Studies, Division of State and Local Support, Louis de la Parte Florida Mental Health Institute, University of South Florida, 1998.

⁴ Croze, C. Managed Behavioral Healthcare Updates. Integration: How Do We Make It Work? Rockville, MD: Substance Abuse and Mental Health Services Administration, August 1999.

A Call to Action

ecause health care providers are charged with the important responsibility of safeguarding the health and well-being of adolescents and their families, they can play a pivotal role in recognizing and getting care for young patients who develop an alcohol-related or drug-related health or behavioral problem. Identifying and getting help for these young people is important for many reasons.

• Substance abuse puts millions of adolescents at risk for serious consequences such as alcohol-related and drug-related traffic accidents and other unintentional injuries; delinquent and criminal behavior; mental health problems; and sexual practices that place them at increased risk for unplanned pregnancies as well as HIV/AIDS, hepatitis C, and other sexually transmitted diseases.¹

• In 1998, nearly 10 percent of adolescents (age 12 to 17) reported using an illicit drug at least once during the past month. About 1 in 12 young people (8.3 percent) in this age group were current users of marijuana at that time.²

• An estimated 10.5 million current drinkers are age 12 to 20. Of this group, 5.1 million engage in binge drinking, including 2.3 million who would also be classified as heavy drinkers.²

• In 1998, an estimated 59,086 emergency department drug episodes occurred among adolescents age 12 to 17. Marijuana/hashish was involved in an estimated 13,135 of these episodes, and cocaine was involved in an estimated 4,309.³

• Although addictions to alcohol and illicit drugs are disorders commonly seen in medical practice, the problem is poorly diagnosed by physicians.⁴ In one study, 45 percent of patients presenting for addiction treatment reported that the physician who cared for them was unaware of their substance abuse problem.⁵

• In a 1996 survey, only 46 percent of the responding pediatricians in direct patient care reported diagnosing a patient with a substance abuse problem in the past year. The largest number of diagnosed substance abuse cases was among youth age 15 to 16, and alcohol was the most frequently abused substance among adolescents.⁶

Getting Involved—Next Steps

Health care providers—such as pediatricians, psychologists, social workers, school nurses and counselors, and emergency room physicians—can help adolescents get the help they need by establishing rapport with their patients, creating opportunities to discuss the use of alcohol and illicit drugs, and recognizing and acting on the signs of substance abuse. Here are some steps that health care providers, especially those engaged in direct patient care, can take to help adolescents deal with substance abuse problems.

• Screening
  Screen adolescents for substance abuse every time they seek medical treatment, particularly if they come from a family with a history of alcohol or drug addiction or present with substantial behavioral changes, emergency medical services for trauma, or sudden medical problems such as accidents, injury, or gastrointestinal disturbance.^{1, 7}

Use a structured or semistructured screening interview that focuses on substance abuse severity and a core group of associated factors such as legal problems, mental health status, educational functioning, and living situation. Select screening instruments based on their reliability and validity specifically for adolescent populations in a particular type of treatment setting.¹

Screen adolescents for a family history of addiction. Be sure to communicate the increased risks for addiction and related problems to youth with a family history of substance abuse.⁸

Support the establishment of standardized screening and assessment tools for use by everyone who works with young people in your community.¹

• Assessment
  Conduct or provide a referral to a comprehensive assessment for all adolescents whose screening reveals indicators (e.g., daily use of one or more substances) of serious substance abuse problems.¹

Use an assessment instrument with established reliability and validity that was developed specifically for young people.¹

Gather information to evaluate whether a substance abuse problem exists, the severity and consequences of the disorder, any related problems such as mental health problems or parental or sibling addiction, the extent to which the youth’s family can be involved in assessment and possible interventions, and the youth’s strengths or coping skills.¹

Develop a written report that includes a treatment plan of action and recommendations for referrals to agencies or services.¹

• Referrals to Treatment
  Become familiar with your community’s substance abuse treatment and recovery programs, particularly those with services tailored to meet the needs of adolescents.⁷

Develop a relationship with contact persons at each program to facilitate your young patient’s access to the program.⁷

Collect referral information on resources such as self-help and recovery groups in your area.⁷

• Other Action Steps
  Make posters and other materials on substance abuse available in your waiting room for adolescent patients and their parents or guardians.

Become fully conversant in substance abuse issues for adolescents, including clinically diverse manifestations produced by alcohol and illicit drugs; diagnostic, treatment, and recovery issues specific to children of substance abusing parents; physical and mental health problems associated with adolescent substance abuse; successful treatment models for adolescents; and skills for supporting teens in recovery.

Support integration of training on substance abuse and addictive disorders into the curricula (including ongoing continuing education) for all health professionals and social workers. Training should address addiction, treatment, and recovery issues for adolescents and should emphasize the development of positive views about working with patients who have addictive disorders.⁴

Serve as a member of an interdisciplinary and multi-agency team to provide a continuum of care, including post-treatment services, to adolescents in treatment and recovery.

Learn about confidentiality issues related to substance abuse services for adolescents. Consult Chapter 8 of Treatment of Adolescents With Substance Use Disorders, in the Center for Substance Abuse Treatment’s Treatment Improvement Protocol (TIP) Series, Number 32, available at no cost through the National Clearinghouse for Alcohol and Drug Information (see resource list below) or the Treatment Improvement Exchange at csat.samhsa.gov/.⁹

Additional Resources for Health Professionals Who Serve Adolescents

American Academy of Child and Adolescent Psychiatry
3651 Wisconsin Avenue, NW
Washington, DC 20016-3007
202-966-7300
www.aacap.org

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
847-228-5005
www.aap.org

American Medical Association
515 North State Street
Chicago, IL 60610
312-464-5000
www.ama-assn.org

American Psychiatric Association
1400 K Street, NW
Washington, DC 20005
202-682-6000
www.psych.org

American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
202-336-5857
www.apa.org

American Society of Addiction Medicine
4601 North Park Avenue, Arcade Suite 101
Chevy Chase, MD 20815
301-656-3920
www.asam.org

National Adolescent Health Information Center
Division of Adolescent Medicine, Department of Pediatrics and Institute for Health Policy Studies
School of Medicine
University of California, San Francisco
1388 Sutter Street, Suite 605A
San Francisco, CA 94109
415-502-4856

National Association for Children of Alcoholics
11426 Rockville Pike, Suite 100
Rockville, MD 20852
888-55-4COAS
www.nacoa.net

National Association of Alcoholism and Drug Abuse Counselors
1911 North Fort Myer Drive, Suite 900
Arlington, VA 22209
800-548-0497 or 703-741-7686
www.naadac.org

National Association of School Psychologists
4340 East West Highway, Suite 402
Bethesda, MD 20814
301-657-0270
www.nasponline.org/index2.html

National Association of Social Workers
750 First Street NE, Suite 700
Washington, DC 20002-4241
202-408-8600
www.socialworkers.org

National Council on Alcoholism and Drug Dependence, Inc.
12 West 21st Street
New York, NY 10010
212-206-6770
www.ncadd.org

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
703-684-7722
800-433-5959 (TTY)
www.nmha.org

Physician Leadership on National Drug Policy
Center for Alcohol and Addiction Studies
Brown University
Box G-BH
Providence, RI 02912
401-444-1817
http://caas.caas.biomed.brown.edu/plndp

Society for Adolescent Medicine
1916 NW Copper Oaks Circle
Blue Springs, MO 64015
816-224-8010
www.adolescenthealth.org

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
National Helpline
800-662-HELP (800-662-4357)
(for confidential information on substance abuse treatment and referral)

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686
ncadi.samhsa.gov

Sources

¹ Center for Substance Abuse Treatment. Screening and Assessing Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No 31. DHHS Publication No. (SMA) 99-3282. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

² Summary Findings from the 1998 National Household Survey on Drug Abuse. DHHS Publication No. (SMA) 99-3328. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 1999.

³ Year-End 1998 Emergency Department Data from the Drug Abuse Warning Network. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, December 1999. (Accessed February 4, 2000.)

⁴ Klamen, D.L. Education and Training In Addictive Diseases. Psychiatric Clinics of North America 22(2):471-480, 1999.

⁵ Saltz, R., Mulvey, K.P., Plough, A., Samet, J.H. Physician Unawareness of Serious Substance Abuse. American Journal of Drug and Alcohol Abuse 23(3):343-354, 1997.

⁶ American Academy of Pediatrics. Periodic Survey of Fellows: Pediatricians, Patients, and Substance Abuse. 1996. URL: http://www.aap.org/research/PS6A.htm (Accessed December 16, 1999.)

⁷ Center for Substance Abuse Treatment. A Guide to Substance Abuse Services for Primary Care Physicians. Treatment Improvement Protocol (TIP) Series, No. 24. DHHS Publication No. (SMA) 97-3139. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1997.

⁸ Adger, Jr. H.A., MacDonald, D.I., Wenger, S. Core Competencies for Involvement of Health Care Providers in the Care of Children in Families Affected by Substance Abuse. Pediatrics, Supplement 103;(5 Pt 2):1083-1084, May 1999.

⁹ Center for Substance Abuse Treatment. Treatment of Adolescents With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 32. DHHS Publication No. (SMA) 99-3283. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

Call to Action

s the "home away from home" for many students, schools can play an important role in identifying youth with substance abuse problems and helping them find the treatment and support they need. Consider these facts:

• More than half of all students in the United States say their school is not drug-free. Teens who attend schools where illicit drugs are stashed, used, or sold, are two times more likely to have marijuana offered to them, and three times more likely to use marijuana. They are also two times more likely to know a teenager who uses LSD, cocaine, or heroin, and nearly three times more likely to smoke cigarettes.¹

• Teens in self-identified drug-free schools are two times more likely to report to school authorities other teens who use or sell illicit drugs on school grounds.¹

• While on school property, nearly 15 percent of students in the United States smoke cigarettes, almost 6 percent have at least one alcoholic drink, and 7 percent use marijuana. Nearly one-third of students are offered, sold, or given an illegal drug while on school property.²

• About 56 percent of all 17-year-olds know a drug dealer at school. More than one-third of 15 to 17-year-olds and 16 percent of 12 to 14-year-olds have actually seen drugs sold on school grounds.³

• Substance abuse is associated with antisocial and violent behavior. When young people are under the influence, they are more likely to engage in risky behaviors and sexual experimentation.⁴

• Marijuana use impairs skills related to attention, memory, and learning, even after use of the drug has been discontinued for at least 24 hours. Research on marijuana use in young people below college age indicates that users of the drug have lower achievement than nonusers.⁵

Getting Involved—Next Steps

Schools offer unique opportunities to identify young people with substance abuse problems. Schools can also take an active role in referring students to treatment and supporting their recovery. Here are some tips on what schools can do to address substance abuse problems.

• Recognize, assess, and monitor the extent of substance abuse among youth in school, on school grounds, and in the community. The knowledge gained will lay the foundation for your school’s policy on youth substance abuse.

• Stay abreast of emerging trends in adolescent substance abuse, such as increased use of anabolic steroids and club drugs.

• Involve parents and students in the development, implementation, and evaluation of your school system’s drug and alcohol education effort.

• After your school system’s policy is established, communicate the policy to all students. Explain the consequences of using alcohol or illicit drugs. Enforce the policy firmly and consistently. Logical consequences should include mandatory meetings with parents, referrals to appropriate treatment or counseling, and options for permitting students to continue their academic studies while suspended or expelled.

• Establish policies for supporting students in recovery as they return to the classroom, such as ongoing counseling, tutoring, and support groups led by either professionals, peers, or both.

• Work with community groups and agencies to develop comprehensive and coordinated treatment and support systems for young people with substance abuse problems and their families.

• Make drug and alcohol education an integral part of your school system’s curriculum, beginning in kindergarten and continuing through 12th grade.

• Select age-specific, culturally appropriate curricula. Make sure the curricula emphasize a consistent "no-use" message; encourage civic responsibility and respect for local laws; and promote good health, self-confidence, and resistance to negative peer pressure. Include information on the benefits of substance abuse treatment and resources for recovery. Establish mechanisms for evaluating curricula.

• Create positive, drug-free and alcohol-free activities for students, such as music, art, dance, and theater programs; sports; leadership training; and after-school or summer programs. These types of activities can promote self-esteem, personal resilience, and the development of refusal skills.

• Train administrators, teachers, and support staff on what to do if a student is suspected of substance abuse.

• Establish a team of individuals, including school nurses and counselors, who are trained to recognize substance abuse problems and make treatment referrals. Make sure that sufficient attention is given to identifying, assessing, and counseling students with substance abuse and mental health problems. Provide parents and youth with treatment information, resources, and referrals.

• Create student-to-student peer support groups so that students with substance abuse problems can learn from the experiences of other students who understand the temptations to use alcohol and drugs, and have found effective ways to reject them. Involve students who are in recovery so they can attest to the benefits of treatment. Support student assistance programs.

Additional Resources for Schools and the Education Community

American Council for Drug Education
164 West 74th Street
New York, NY 10023
800-488-DRUG
www.acde.org (for information)
800-DRUG HEL(P)
www.drughelp.org (for referrals)

Drug Enforcement Administration
Demand Reduction Program
Washington, DC 20537
202-307-7936
www.usdoj.gov/dea

Join Together
441 Stuart Street, 7th Floor
Boston, MA 02116
617-437-1500
www.jointogether.org

National Association of School Psychologists
4340 East West Highway, Suite 402
Bethesda, MD 20814
301-657-0270
301-657-4155 TDD
www.nasponline.org/index2.html

National Association for Children of Alcoholics
11426 Rockville Pike, Suite 100
Rockville, MD 20852
888-554-COAS
www.nacoa.net

National Association for Student Assistance Professionals
4200 Wisconsin Avenue, NW, Suite 106-118
Washington, DC 20016
800-257-6310
www.nasap.org

National Council on Alcoholism and Drug Dependence, Inc.
12 West 21st Street
New York, NY 10010
212-206-6770
800-NCA-CALL (Hopeline)
www.ncadd.org

National Institute on Alcohol Abuse and Alcoholism
Keeping Kids Alcohol Free Campaign
6000 Executive Boulevard
Willco Building
Bethesda, MD 20892-7003
301-496-4000
www.niaaa.nih.gov

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA voice or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

National Peer Helping Association
4922 State Line Road
Westwood Hills, KS 66205-1964
www.peerhelping.org

Students Against Destructive Decisions National
Box 800
Marlboro, MA 01752
800-787-5777
www.saddonline.com

Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Knowledge Exchange Network
P.O. Box 42490
Washington, DC 20015
800-789-2647
www.mentalhealth.samhsa.gov

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
National Helpline
800-662-HELP (800-662-4357)
(for confidential information on substance abuse treatment and referral)

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686
ncadi.samhsa.gov

Girl Power!* Campaign Headquarters
11426 Rockville Pike
Rockville, MD 20852
800-729-6686
www.girlpower.gov

* Girl Power! is a national public education campaign sponsored by the U.S. Department of Health and Human Services with leadership from the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention, the Office on Women’s Health, and the Office of the Secretary.

National PTA Drug and Alcohol Abuse Prevention Project
330 North Wabash Avenue, Suite 2100
Chicago, IL 60611-3690
800-307-4782
www.pta.org

U.S. Department of Education
Safe and Drug-Free Schools
400 Maryland Avenue, SW
Washington, DC 20202-6123
877-433-7827
www.ed.gov/offices/OESE/SDFS

Sources

¹ National Center on Addiction and Substance Abuse at Columbia University, Back to School 1999—National Survey of American Attitudes on Substance Abuse V: Teens and Their Parents. New York, NY: National Center on Addiction and Substance Abuse at Columbia University, 1999.

² Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 1997. Morbidity and Mortality Weekly Report 47(31), 1998.

³ National Center on Addiction and Substance Abuse at Columbia University, National Survey of Teens, Teachers and Principals. New York, NY: National Center on Addiction and Substance Abuse at Columbia University, 1999.

⁴ Schonberg, S.K., ed. Substance Abuse: A Guide for Health Professionals. Elk Grove Village, IL: American Academy of Pediatrics, 1988.

⁵ National Institute on Drug Abuse (NIDA). Marijuana (InfoFax fact sheet). Rockville, MD: NIDA, National Institutes of Health, 1999.

A Call to Action

clear link exists between substance abuse and juvenile delinquency as well as between substance abuse and the need for child protective services. Crime related to substance abuse is a public health crisis. The juvenile justice and family court systems can help apply public health solutions to these problems by promoting the early recognition and treatment of substance abuse.

Developing processes to detect substance abuse problems is a key action the juvenile justice system can take to enhance rehabilitation of young people and decrease the likelihood of continued delinquent or criminal behavior. The juvenile justice system also can join forces with communities to ensure that juvenile offenders receive effective treatment for their substance abuse problems. Here are some of the facts about adolescent substance abuse, juvenile delinquency, and the juvenile justice system:

• A U.S. Department of Justice study of youth age 11 to 17 indicates that substance use and involvement in delinquent behavior are clearly interrelated, with substance use stimulating delinquency over time more than the reverse.¹

• Juveniles under age 18 were involved in 25 percent of liquor law violations and 13 percent of drug abuse violation arrests in 1998. The number of juvenile arrests for drug abuse violations rose 86 percent between 1989 and 1998.²

• In 1998, 40 to 60 percent of juvenile male arrestees or detainees in major U.S. cities tested positive for illegal substances, primarily marijuana.³

• An estimated 250,000 adolescents who enter the juvenile justice system in the United States each year have a diagnosable substance abuse problem.⁴

• Many adolescents entering the juvenile justice system have multiple problems in addition to substance abuse—including a history of physical or sexual abuse, psychological and emotional problems, family difficulties, and poor performance in school—that place them at significant risk for return to substance abuse and further delinquent behavior.⁴

• In most jurisdictions, the juvenile justice system lacks sufficient resources to provide appropriate substance abuse treatment and recovery services for adolescents. In many cases, juveniles are removed from the community and sent to training schools, boot camps, or other residential facilities instead of substance abuse treatment programs.⁵

• A series of studies on juvenile drug courts and drug treatment programs found that the most consistently effective programs—including skills training, multiple services, community-based residential treatment, and restitution-probation/ parole—can reduce recidivism by 14 to 44 percent.⁶

• Substance abusing juvenile offenders who gain access to, participate in, and complete treatment decrease their subsequent substance abuse and delinquent behaviors. In one national study, treatment for adolescents reduced rates of criminal activity such as illicit drug dealing, property crime, and violent crime.⁷

• Among the benefits of breaking the cycle of drug use and crime among juvenile offenders is an estimated saving of $150,000 to $360,000 per youth in present value costs that would otherwise be generated by an average lifetime of heavy cocaine or heroin abuse.⁸

Getting Involved—Next Steps

Juvenile justice professionals—such as judges, juvenile court services staff, and probation and parole officers—can be important partners in ensuring that adolescents in the juvenile justice system get the treatment they need for substance abuse problems and related problems. Here are some steps that can be taken within the juvenile justice system.

• Screening and Assessment
  Use screening and assessment instruments for all adolescents for substance abuse and mental health problems soon after arrest or detention. Include "status offenders" who are not usually screened.⁴

Repeat screening and assessment at different stages in the system (e.g., intake, preadjudication, and postadjudication) to detect changes over time in the pattern of substance abuse, related problem behaviors, and the need for services.⁴

Train juvenile justice professionals, including judges and other court personnel, to identify and refer to treatment clients with substance abuse problems at the earliest possible intervention point.^{4, 9}

Develop procedural and decisionmaking guidelines regarding referrals for further assessment of substance abuse and mental health problems, and for other community services. Include threshold criteria for referral in the guidelines.⁴ Collaborate with clinical staff from community social service agencies to develop the procedures for triage and referrals to substance abuse treatment and recovery programs.⁴

Train juvenile justice system staff to understand and maintain the confidentiality of screening and assessment information and to understand key issues related to informed consent.⁴

• Treatment Programs and Alternatives to Incarceration
  Partner with various systems such as substance abuse treatment programs, physical and mental health services, social services, faith communities, schools, and community-based organizations to help provide holistic, culturally relevant, and gender-specific treatment and recovery services to juvenile offenders.¹⁰

Maintain a rehabilitation perspective in the juvenile justice system.¹¹

Improve treatment and recovery services for juvenile offenders with coexisting mental disorders. Provide cross-training to improve the ability of juvenile justice and mental health staff to deal with juvenile offenders who have substance abuse problems.¹¹

Provide alternatives to incarceration that can help specific youth with substance abuse problems to avoid escalating involvement with the juvenile justice system. Include an array of diversion programs such as intensive community supervision, day reporting centers, day treatment, afterschool programs, evening and weekend programs, close supervision or "tracking programs," electronic monitoring, home detention, home and mentor tutoring, work and apprenticeship, restitution, community service, and volunteer programs.¹⁰

Develop clear and concise guidelines to determine who is eligible for diversion programs, to ensure equitable treatment for all juveniles in such programs, and to protect the juvenile’s due process rights.¹²

Use a single case manager to coordinate services and serve as the central monitoring and tracking source for each adolescent.¹⁰

Consider implementing juvenile drug courts for certain first-time offenders to provide immediate intervention and close supervision. Court actions should be coordinated with the families, school system, treatment service providers, and other community agencies.^{10, 12}

Provide support and intervention services to address important issues for children of alcohol or drug abusing parents.

Encourage parent and family participation in adolescent substance abuse treatment and recovery programs.

• Comprehensive Services for Re-Entry
  Provide a continuum of treatment and recovery services, including after care, for alcohol-involved and drug-involved juvenile offenders on probation. Provide links to community-based treatment and recovery programs to ensure continuing care on release.9

Offer juvenile offenders viable options for completing their education. Make job training and placement available to every adolescent in the juvenile justice system.⁹

Promote positive youth development and outcomes by teaching decisionmaking skills, individual accountability, and resistance to social pressure.⁹

Develop programs that protect juvenile offenders from the effects of parental substance abuse by providing treatment for parents.⁹

Additional Resources for the Juvenile Justice and Family Court Systems

American Bar Association
750 North Lakeshore Drive
Chicago, IL 60611
800-285-2221
www.abanet.org

American Probation and Parole Association
P.O. Box 11910
Lexington, KY 40578-1910
606-244-8203
www.appa-net.org

Center on Juvenile and Criminal Justice
1622 Folsom Street, 2nd Floor
San Francisco, CA 94103
415-621-5661
www.cjcj.org

The GAINS Center
(for People With Co-Occurring Disorders in the Justice System)
Policy Research, Inc.
262 Delaware Avenue
Delmar, NY 12054
800-311-4246
www.prainc.com/gains

Juvenile Justice Clearinghouse
P.O. Box 6000
Rockville, MD 20849-6000
800-638-8736
www.ncjrs.org

National Council of Juvenile and Family Court Judges
University of Nevada
P.O. Box 8970
Reno, NV 89507
775-784-6012
www.ncjfcj.unr.edu

National Criminal Justice Reference Service
P.O. Box 6000
Rockville, MD 20849-6000
800-851-3420 or 301-519-5500
www.ncjrs.org

National Institute of Justice
810 Seventh Street, NW
Washington, DC 20531
202-307-2942
www.ojp.usdoj.gov/nij

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
703-684-7722
800-433-5959 (TTY)
www.nmha.org

National Treatment Accountability for Safer Communities (TASC)
1911 North Fort Myer Drive, Suite 900
Arlington, VA 22209
703-522-7212
www.nationaltasc.org

National Youth Court Center
c/o American Probation and Parole Association
P.O. Box 11910
Lexington, KY 40578-1910
606-244-8215
www.youthcourt.net

Office of Juvenile Justice and Delinquency Prevention
810 Seventh Street, NW
Washington, DC 20531
202-307-5911
www.ojjdp.ncjrs.org

Substance Abuse and Mental Health Services Administration
Room 12-105 Parklawn Building
5600 Fishers Lane
Rockville, MD 20857
301-443-8956
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686
ncadi.samhsa.gov

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Sources

¹ Huizinga, D., Loeber, R., Thornberry, T.P. Urban Delinquency and Substance Abuse: Initial Findings. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, 1994.

² Synder, H.N. "Juvenile Arrests 1998," Juvenile Justice Bulletin. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, December 1999.

³ Arrestee Drug Abuse Monitoring Program (ADAM). 19982091 Annual Report on Drug Use Among Adult and Juvenile Arrestees. Washington, DC: National Institute of Justice, U.S. Department of Justice, April 1999.

⁴ Center for Substance Abuse Treatment. Screening and Assessing Adolescents for Substance Use Disorders. Treatment Irnprovement Protocol (TIP) Series, No. 31. DHHS Publication No. (SMA) 99-3282. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

⁵ Center for Substance Abuse Treatment. Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System. Treatment Improvement Protocol (TIP) Series, No. 21. DHHS Publication No. (SMA) 95-3051. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1995.

⁶ Physician Leadership on National Drug Policy (PLNDP). New Studies Find Drug Courts and Drug Treatment of Prisoners, Parolees, and Teens Cut Crime and Drug Use (news release). Providence, Rl: PLNDP, November 1998.

⁷ Powers, K., Hser, Y-I.; Grella, C., Anglin, M.D. Differential Assessment of Treatment Effectiveness on Property Crime and Drug Dealing Among Adolescents. Presented at the College on Problems of Drug Dependence Annual Meeting, June 1999. URL: http://www.datos.org/posters/CPDD_99_Powers/index.htm (Accessed December 21, 1999.)

⁸ Synder, H.N. and Sickmund, M. Juvenile Offenders and Victims: 1999 National Report. National Center for Juvenile Justice, 1999.

⁹ Center for Substance Abuse Prevention. Making Prevention Work: Actions for Juvenile Justice and Child Welfare (fact sheet). Rockville, MD: Substance Abuse and Mental Health Services Administration, 1995. URL: http://ncadi.samhsa.gov/pubs/mpw-fact/mpw020.htm (Accessed December 20, 1999.)

¹⁰ Center for Substance Abuse Treatment. Treatment of Adolescents With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 32. DHHS Publication No. (SMA) 99-3283. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

¹¹ Bilchik, S. Mental Health Disorders and Substance Abuse Problems Among Juveniles (fact sheet). Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, July 1998.

¹² Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project. Juvenile and Family Drug Courts: An Overview. Washington, DC: Drug Courts Program Office, Office of Justice Programs, U.S. Department of Justice, June 1998.

A Call to Action

ncreasing numbers of adolescents are entering the workplace. In fact, the number of workers age 16 to 19 is projected to approach 9 million by 2006.¹ These adolescents will form a significant portion of the labor pool from which businesses will draw during the coming decade. Therefore, efforts within the workplace to identify and get help for young people who have substance abuse problems are a vital contribution to ensuring the health and productivity of this future labor pool. Here are some facts:

• Substance abuse among adolescents is a serious public health problem. More than half of 12th graders in the United States have used an illicit drug, and past-month use of alcohol in 1999 was 24 percent for 8th graders, 40 percent for 10th graders, and 51 percent for 12th graders.²

• Overall, more than half (57 percent) of young people participate in some type of work activity while age 14, and almost two-thirds (64 percent) work at some point while age 15.³

• The approximately 20 percent of adolescents who work for more than 20 hours per week are at greater risk for a range of health problems, including depression and substance abuse.⁴

• During the summer, more than 3 million youth under age 18 work at summer jobs. Most adolescents (51 percent) work in the retail industry, which includes fast-food outlets and food stores.⁵

• Substance abuse has a significant impact in the workplace, with costs estimated at over $100 billion annually.6 For example, alcoholism causes 500 million lost workdays each year.⁷

• Substance-abusing employees average more sick days than employees without substance abuse problems, and they are also more likely to be involved in a workplace accident.⁸

• Substance abuse treatment significantly reduces medical claims, absenteeism, and disability; increases productivity; and results in a healthier and safer environment for all employees.

Getting Involved—Next Steps

• Establish a workplace substance abuse program to reflect your company’s commitment to a work environment free of substance abuse. These programs should include a written substance abuse policy statement, supervisor training, employee education and awareness, and assistance to employees needing help. If you have an employee assistance program in place, ensure that it addresses substance abuse and younger workers.

• Conduct an evaluation of your workplace to ensure that it is a safe and "recovery friendly" environment. For example, consider safe and sober office celebrations, along with traffic safety facts related to drunk driving.

• Avoid workplace conditions that are associated with employee drinking problems, including limited work supervision, low job autonomy, boring or isolating work, and available or accessible alcohol.⁹

• Recognize the on-the-job warning signs of adolescent alcohol and drug abuse.¹⁰ Keep in mind, however, that while these signs may be indicative of potential substance abuse, they can also indicate other problems and do not constitute a definitive diagnosis. Some of these signs and symptoms include:

• Inconsistent work quality
• Poor concentration
• Lowered productivity
• Increased absenteeism
• Unexplained disappearances from the job site
• Carelessness, mistakes
• Errors in judgment
• Needless risk-taking
• Disregard for safety
• Regular injuries and accidents on the job
• Extended lunch periods and early departures
• Fatigue
• Repeated health complaints
• Frequent financial problems
• Red and glazed eyes
• A lasting cough
• Personality changes or sudden mood swings
• Irritability
• Apathy

• Educate all employees about the warning signs of substance abuse, particularly first-line supervisors who have the greatest amount of contact with adolescent employees. Supervisors should be educated about the value of treatment and recovery, rather than firing people with substance abuse problems or addictive disorders.

• Display in employee lounges or locker rooms posters and other educational materials on the dangers of substance abuse and how to seek help for substance abuse problems.

• Help your adolescent employees find the help they need. You may want to compile a list of drug education, treatment, and recovery services available in your community that can be shared with employees who may have substance abuse problems. If you have an employee assistance program at your company, use it as a resource for education, guidance, referral, and treatment.

• Provide parents of teens in your workplace with information and tools to give positive messages to their children about drug abuse.

Additional Resources for the Workplace

Employee Assistance Professionals Association
2101 Wilson Boulevard, Suite 500
Arlington, VA 22201
703-522-6272
www.eap-association.com

Employee Assistance Society of North America
435 North Michigan Avenue, Suite 1717
Chicago, IL 60611-4067
312-644-0828

Institute for a Drug-Free Workplace
1225 I Street, NW, Suite 1000
Washington, DC 20005
202-842-7400
www.drugfreeworkplace.org

Working Partners for an Alcohol and Drug-Free Workplace
U.S. Department of Labor
200 Constitution Avenue, NW, Room S-2312
Washington, DC 20210
202-219-6001, ext. 152 or 137
www.dol.gov/dol/workingpartners.htm

National Association for Student Assistance Professionals
4200 Wisconsin Avenue, NW, Suite 106-118
Washington, DC 20016
1-800-257-6310
www.nasap.org

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Prevention
Workplace Hotline
800-967-5752
www.samhsa.gov/centers/csap/csap.html

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
National Helpline
800-662-HELP (800-662-4357)
(for confidential information on substance abuse treatment and referral)

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686
ncadi.samhsa.gov

Sources

¹ U.S. Bureau of Labor and Statistics. Actual and Projected Labor Force. URL: www.bls.gov/. (Accessed November 9, 1999.)

² National Institute on Drug Abuse. Drug Use Among Teenagers Leveling 0ff. (News Release). Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 1999. URL: http://www.drugabuse.gov/MedAdv/99/NR-1217a.html (Accessed December 20, 1999.)

³ U.S. Bureau of Labor and Statistics. Employment Experience and Other Characteristics of Youths: Results from a New Longitudinal Survey Summary. April 30, 1999.

⁴ Resnick, M.D., et al. Protecting Adolescents From Harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 278(10):823-32, 1997.

⁵ U.S. Department of Labor. Work Safe this Summer (And Beyond). Protecting Working Teens (fact sheet). URL: www.dol.gov/dol/topic/youthlabor/StudentWorkers.htm#doltopics

⁶ Falco, M. The Making of a Drug-Free America: Programs That Work. New York: Times Books, 1992.

⁷ National Association of Treatment Providers. Treatment is the Answer: A White Paper on the Cost-Effectiveness of Alcoholism and Drug Dependency Treatment. Laguna Hills, CA: National Association of Treatment Providers, March 1991.

⁸ Backer, T.E. Strategic Planning for Workplace Drug Abuse Programs. National Institute on Drug Abuse, National Institutes of Health, 1987 (page 4).

⁹ Alcohol and the Workplace. Alcohol Alert, No. 44, JuIy 1999.

¹⁰ American Academy of Child and Adolescent Psychiatry. The Practice Parameter for the Assessment and Treatment of Children and Adolescents with Substance Use Disorders, October 1997.

A Call to Action

aith-based organizations, athletic and recreational groups, civic organizations, and similar community groups share a common goal—to serve the community and the people who live in it. Community organizations can have a positive influence on the lives of young people, including young people who use alcohol and drugs. Because of their day-to-day involvement in the lives of youth, community organizations can help identify adolescents with substance abuse problems, refer them to treatment, and support them throughout the recovery process.

Youth substance abuse is clearly a communitywide challenge that requires a communitywide response. Consider these facts about adolescent substance abuse:

• Nearly half (45 percent) of all deaths from traffic accidents are related to the consumption of alcohol, and an estimated 18 percent of drivers 16 to 20 years old (or 2.5 million adolescents) drive under the influence of alcohol.¹

• Adolescents who use drugs are more likely than nonusing teens to have sex, initiate sexual activities at a young age, and have multiple sex partners, placing them at greater risk for unplanned pregnancies and HIV/AIDS and other sexually transmitted diseases.¹

• Young people who start drinking alcohol at age 13 are four times more likely to develop an alcohol abuse disorder later on in life than someone who starts drinking at age 20.²

• A U.S. Department of Justice study of youth age 11 to 17 indicates that drug use and involvement in delinquent behavior are interrelated, with drug use stimulating delinquency over time.³

Getting Involved—Next Steps

There are a number of ways in which community organizations serving youth can get involved in creating a healthier community environment for youth. Here are a few examples:

• Consult with community leaders working in substance abuse and related areas to assess the extent of youth alcohol and drug use, and community awareness of the problem.

• Learn about efforts already under way in the community to address youth substance abuse.

• Stay abreast of local trends in adolescent substance abuse. Monitor drug-related and alcohol-related deaths reported by your local medical examiner, emergency departments, treatment programs, and criminal justice data. If you notice new trends or sharp increases, notify local policymakers and the public. Develop a plan for how your organization can help.

• Forge new partnerships with other youth-serving organizations, such as faith-based groups, schools, recreational programs, and other organizations in the community, to make adolescent substance abuse prevention, treatment, and recovery a communitywide priority. Work together to limit the availability of alcohol and drugs in your community and to reduce the temptation to use these substances.

• Establish linkages with a diverse range of treatment facilities in your community so that your organization can refer youth with substance abuse problems for appropriate care.

• Establish and enforce a clear, "no-use" policy regarding alcohol and drugs at all youth activities. Communicate the consequences of violating this policy.

• Provide and supervise "safe havens" for young people to gather when they are feeling pressured by friends or drug dealers to drink alcohol or use illicit drugs. Sponsor appealing, drug-free and alcohol-free activities for youth, such as social, recreational, musical, and athletic events. Encourage parks, recreation centers, and other youth-serving organizations to do the same.

• Host a range of prevention and treatment support groups or recovery meetings, including groups for children of parents who abuse alcohol and drugs. Carefully consider the credentials and experience of the staff to be recruited and provide comprehensive training.

• Join forces with local media to communicate messages about the importance of preventing, identifying, and treating adolescent substance abuse.

• Encourage adolescents who have gone through substance abuse treatment to serve as role models and resources for youth who need treatment.

• Educate young athletes—both male and female—about the dangers of steroids and other performance-enhancing drugs. If you suspect that an athlete is using illicit drugs, confront him or her immediately. Set no-use rules, and enforce them consistently. Ensure that everyone on your coaching staff sets a good example.

• Include information in your organization’s publications and newsletters about substance abuse treatment hotlines and other resources for adolescents.

• Provide mentoring opportunities for caring adults in the community.

• Get involved in community activities to improve local substance abuse prevention and treatment efforts. Educate local leaders that youth substance abuse is a serious public health concern. Encourage a holistic, comprehensive approach to communitywide substance abuse treatment that builds on the strengths of the family and community.

• Join forces with local schools, faith organizations, community agencies, and other youth-serving organizations to sponsor educational seminars, workshops, and discussions on how parents can identify young people with drug or alcohol problems and support them throughout the recovery process. Organize community fairs and local public awareness campaigns to educate families about substance abuse among youth and the resources available in the community.

• Work to create a healthy community. Sending young people in recovery back into an unhealthy community environment can severely jeopardize the effectiveness of treatment and ongoing recovery.

• Always remember that helping one teenager recover from alcohol or drug abuse can have a positive influence on the attitudes and behaviors of his or her friends.

Additional Resources for Community-Based Organizations Serving Youth

4-H
1400 Independence Avenue, SW
Washington, DC 20250-2225
202-720-2908
www.fourhcouncil.edu/

American Public Health Association
800 I Street, NW
Washington, DC 20001
202-777-2742 (APHA)
202-777-2500 (TTY)
www.apha.org

Association of State and Territorial Health Officials
1275 K Street, NW, Suite 800
Washington, DC 20005-4006
202-371-9090
www.astho.org

Big Brothers/Big Sisters of America
230 North 13th Street
Philadelphia, PA 19107
215-567-7000
www.bbbsa.org

Boy Scouts of America
National Office
1325 West Walnut Hill Lane
P.O. Box 152079
Irving, TX 75015-2079
572-580-2000
www.bsa.scouting.org

Boys & Girls Clubs of America
1230 West Peachtree Street, NW
Atlanta, GA 30309
404-815-5700
www.bgca.org

Catholic Charities, USA
1731 King Street, Suite 200
Alexandria, VA 22314
703-549-1390
www.catholiccharities.org

Catholic Youth Organization
305 Michigan Avenue
9th floor
Detroit, MI 48226-2614
313-963-7172

Church of Jesus Christ of Latter Day Saints
529 14th Street, NW, Suite 900
Washington, DC 20045
202-662-7480
www.lds.org

Community Anti-Drug Coalitions of America
901 North Pitt Street, Suite 300
Alexandria, VA 22314
800-54-CADCA
www.cadca.org

Congress of National Black Churches
National Anti-Drug Campaign
1225 I Street, NW, Suite 750
Washington, DC 20005
202-371-1091
www.cnbc.org

The Fellowship of Christian Athletes
8709 Leeds Road
Kansas City, MO 64129
816-921-0909
www.gospelcom.net/fca

General Board of Global Ministries of the United Methodist Church
Program on Substance Abuse and Related Violence
110 Maryland Avenue, NE, Suite 404
Washington, DC 20002
202-548-2712
202-548-2712

Girl Power!* Campaign Headquarters
11426 Rockville Pike
Rockville, MD 20852
800-729-6686
www.girlpower.gov

* Girl Power! is a national public education campaign sponsored by the U.S. Department of Health and Human Services with leadership from the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention, the Office on Women’s Health, and the Office of the Secretary.

Girl Scouts
Just for Girls, 15th Floor
Girl Scouts of the U.S.A.
420 Fifth Avenue
New York, NY 10018-2798
800-GSUSA4U
www.girlscouts.org

Jewish Alcoholics, Chemically Dependent Persons and Significant Others
850 Seventh Avenue
New York, NY 10019
212-397-4197
www.jacsweb.org

Junior Achievement
One Education Way
Colorado Springs, CO 80906
www.ja.org

Little League (Central Region)
9802 East Little League Drive
Indianapolis, Indiana 46235
317-897-6127
e-mail: centralregion@littleleague.org
www.littleleague.org

Little League (East Region)
335 Mix Street
Bristol, CT 06010
860-585-4730
e-mail: eastregion@littleleague.org
www.littleleague.org

Little League (South Region)
658 58th Street South
St. Petersburg, FL 33707
727-344-2661
e-mail: southregion@littleleague.org
www.littleleague.org

Little League (West Region)
6707 Little League Drive
San Bernardino, CA 92407
909-887-6444
e-mail: westregion@littleleague.org
www.littleleague.org

National Association for Children of Alcoholics
11426 Rockville Pike, Suite 100
Rockville, MD 20852
888-554-COAS
www.nacoa.net

National Association of Community Health Centers, Inc.®
1330 New Hampshire Avenue, NW, Suite 122
Washington, DC 20036
202-659-8008
www.nachc.com

National Association of Rural Health Clinics
426 C Street, NE
Washington, DC 20002
202-543-0348
www.narhc.org

National Council for Community Behavioral Healthcare
12300 Twinbrook Parkway, Suite 320
Rockville, MD 20852
301-984-6200
www.nccbh.org

National Council on Alcoholism and Drug Dependence, Inc.
12 West 21st Street
New York, NY 10010
212-206-6770
800-NCA-CALL (Hopeline)
www.ncadd.org

National High School Athletic Coaches Association
P.O. Box 2569
Gig Harbor, WA 98335
253-853-6777
www.hscoaches.org

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
National Helpline
800-662-HELP (800-662-4357)
(for confidential information on substance abuse treatment and referral)

National Directory of Drug Abuse and Alcoholism Treatment Programs
www.samhsa.gov

Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Knowledge Exchange Network
P.O. Box 42490
Washington, DC 20015
800-789-2647
www.mentalhealth.samhsa.gov/CMHS

Young Men’s Christian Association of the USA
1701 K Street, NW, Suite 903
Washington, DC 20006
202-835-9043
www.ymca.net

Young Women’s Christian Association
YWCA of the U.S.A.
Empire State Building
350 Fifth Avenue, Suite 301
New York, NY 10118
212-273-7800
www.ywca.org

Sources

¹ Center for Substance Abuse Treatment. Screening and Assessing Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 31. DHHS Publication No. (SMA) 99-3282. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

² Grant, B.F., Dawson, D.A. Age at Onset of Alcohol Use and Its Association with DSM-IV Alcohol Abuse and Dependence. Journal of Substance Abuse 9:103-110, 1997.

³ National Center on Addiction and Substance Abuse at Columbia University. Dangerous Liaisons: Substance Abuse and Sex. New York, NY: National Center on Addiction and Substance Abuse at Columbia University, 1999.

A Call to Action

arents are in a unique position to identify and get treatment for their teenage children who are using alcohol and illicit drugs. Be aware that any child—regardless of race, ethnicity, gender, religion, or socioeconomic background—can develop a substance abuse problem. By paying attention to your children and knowing the facts, you will be better able to recognize substance abuse problems and take action. Here are some facts parents should know:

• Adolescent substance abuse can start early. The average age for young people to start using tobacco is 12. The average age they start drinking alcohol is shortly before their 13th birthday. And the average age for young people to start smoking marijuana is 14.¹ Inhalants are most commonly abused among adolescents in their early teens, with 8th graders more likely to be users than 10th or 12th graders.²

• Young people who start drinking alcohol at age 13 are four times more likely to develop an alcohol abuse disorder later on in life than someone who starts drinking at age 20.³

• Even elementary-age children feel pressured to drink alcohol, smoke cigarettes, use illicit drugs, and "huff" inhalants. Approximately 40 percent of 4th, 5th, and 6th graders admit that they would drink alcohol or use crack/cocaine just to fit in or feel older.⁴

• Parents make a difference in their children’s choices about alcohol and drugs. More than 42 percent of teens who have never used marijuana say their parents play an important part in their decision not to use marijuana.⁵ However, children of substance abusing parents who lack intrapersonal and interpersonal skills are at increased risk for school failure, depression, anxiety, and alcohol and drug use.⁶

• Roughly 57 percent of African American parents, 45 percent of Hispanic parents, and 44 percent of white parents say they talk with their children about drugs frequently. However, only 31 percent of African American teens, 29 percent of Hispanic teens, and 19 percent of white teens report having such conversations with their parents or guardian.⁷

Getting Involved—Next Steps

Dealing with substance abuse problems in young people is an important part of parenting today. The good news is—help is available. Teenagers can and do get off drugs. Here are some steps that parents can take.

• If you think you may have a problem with alcohol, prescription drugs, or illicit drugs, get help immediately. Set a good example by not using illicit drugs and responsibly using alcohol. Teach your child or teenager that it is okay to get help, and give young people a clear message about alcohol and drug use.

• Know your family’s history of alcohol and drug abuse, and talk to your children about it.

• Contact national or local substance abuse treatment helplines, such as the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment National Helpline at 800-662-HELP.

• Talk to your children about the dangers of substance abuse. Find out what they already know and think about drugs and alcohol. Be a good listener, and be honest if your teenager asks whether you have used drugs.

• Learn more about specific drugs—especially marijuana, steroids, club drugs, and inhalants. Be able to recognize the paraphernalia associated with drug use, such as pipes, vials, canisters, needles, paper bags, rolling paper, roach clips, and blotters. The more you know, the better equipped you are to determine whether your teenager is abusing drugs.

• Learn how to recognize the potential warning signs of substance abuse, such as changes in sleeping, eating, or grooming habits; hypersensitivity or temper tantrums; unexplained weight loss or gain; red or watery eyes; shaking of the hands, feet, or legs; frequent nausea or vomiting; excessive sweating; a drop in grades at school; skipping school; loss of interest in family activities previously enjoyed; an "I don’t care" attitude; excessive need for privacy or secrecy; or an unexplained need for money or even stealing money. If you see these behaviors, get help.

• If you believe your adolescent is using alcohol or drugs, do not let the stigma associated with substance abuse delay your decision to get help immediately. Make an appointment with a health care professional for an evaluation to determine if your child has a substance abuse problem. Together, you can decide what to do next.

• If you and your health care provider agree that your child needs treatment, get information about services in your community. Ask your health care professional for a referral, or contact local hospitals, state and local substance abuse agencies, school counselors, or community mental health centers.

• Be your child’s advocate. Whether you have private health coverage or you rely on public programs for health care, find out what treatment services are covered and for how long. You may need to solicit certain services and support for your child and your family. Tell your health care professional, insurance company, social worker, case manager, and anyone else involved in your child’s treatment what you think your child and family need. Make sure you are involved in decisions about your child’s treatment.

• Tell your story. Educate other parents in the community about the dangers of alcohol and drug abuse and the benefits of treatment.

• Create an informal network by talking to the parents of your children’s friends and discussing concerns you may have about possible or definite substance abuse.

• Get involved in community activities to improve local substance abuse prevention efforts, and treatment and recovery programs. Educate local leaders that youth substance abuse is a serious public health concern. Support the development of a holistic and comprehensive approach to communitywide substance abuse treatment that builds on the strengths of family and community.

• Join forces with local schools, faith organizations, community agencies, and other youth-serving organizations to sponsor educational seminars, workshops, and discussions on how parents can identify young people with alcohol or drug problems and support them throughout their recovery process. Organize community fairs and local public awareness campaigns to educate families about substance abuse among youth and the resources available in the community.

Additional Resources for Parents and Families

American Council for Drug Education
164 West 74th Street
New York, NY 10023
800-488-DRUG
www.acde.org (for information)
800-DRUG HEL(P)
www.drughelp.org (for referrals)

American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
202-336-5500
www.apa.org

Community Anti-Drug Coalitions of America
901 North Pitt Street, Suite 300
Alexandria, VA 22314
800-54-CADCA
www.cadca.org

Families for Prevention
Experience Education
18512 Q Street
Omaha, NE 68135
800-477-4236
www.exed.com

Hazelden Foundation
P.O. Box 176
Center City, MN 55012-1076
800-257-7800
www.hazelden.org

Join Together
441 Stuart Street, 7th Floor
Boston, MA 02116
617-437-1500
www.jointogether.org

National Association for Children of Alcoholics
11426 Rockville Pike, Suite 100
Rockville, MD 20852
888-554-COAS
www.nacoa.net

National Center for Tobacco-Free Kids
1707 L Street, NW, Suite 800
Washington, DC 20036
800-284-KIDS
www.tobaccofreekids.org

National Council on Alcoholism and Drug Dependence, Inc.
12 West 21st Street
New York, NY 10010
212-206-6770
800-NCA-CALL (Hopeline)
www.ncadd.org

National Institute on Alcohol Abuse and Alcoholism
Keeping Kids Alcohol Free Campaign
6000 Executive Boulevard
Willco Building
Bethesda, MD 20892-7003
301-496-4000
www.niaaa.nih.gov

National Institute on Drug Abuse
National Institutes of Health
Office of Science Policy and Communication
6001 Executive Boulevard
Room 5213 MSC 9561
Bethesda, MD 20892-9561
301-443-1124
Telefax fact sheets: 888-NIH-NIDA (voice) or
888-TTY-NIDA (TTY)
www.drugabuse.gov
www.clubdrugs.org

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971