Expected teen behavior and signs of substance use disorder may look similar. Learn about the symptoms of teen substance use disorder and what to do next.

Have you noticed your teen behaving differently for a period of time? Are they no longer hanging out with or talking with their friends? Have they made new friends you’ve never met? Do they seem more secretive? Are they arguing with you more?

Or, if you’re a teen who regularly uses drugs or alcohol, have your friends or family told you that you seem different? Even if you don’t think your drug use is a problem, have they said some things that may have upset you, but now you’re wondering whether they may be true?

Research shows that the younger a child is when they first try a substance, the more likely they are to continue to use that substance and develop a substance use disorder.

Early drug use can affect some important brain developments, too.

But there is good news: Getting help for a substance use disorder during the teen years often means they’ll recover successfully.

What is a substance use disorder?

Even though alcohol and many drugs are illegal for teens, many young people still experiment for various reasons. The most common substances teens may misuse are:

alcohol
cannabis
tobacco
inhalants, including breathing the fumes of glues, household cleaners, or pens
synthetic cannabinoids like K2 or spice
prescription medication, including opioids
cough medicine
sedatives
MDMA (ecstasy)

When someone uses these or other substances on a regular basis, a healthcare professional may diagnose a substance use disorder.

The professional will follow a set of 11 criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Based on the DSM-5, your teen may have a substance use disorder if they:

take more of the substance than they intended, or take it for longer than they intended
cannot decrease or stop using the substance
spend a lot of time doing things to get, use, or recover from the substance
have cravings for the substance
are using the substance so much that they’re unable to do things like go to school or work, or handle their responsibilities at home
continue to use the substance even though they’re having problems with friends or family because of their substance use
decrease the amount of time they spend with friends or doing activities they once enjoyed, or stop doing them entirely
use the substance under circumstances that may not be safe
continue to use the substance even though they know that it’s causing them problems
have built up a tolerance to the substance
experience withdrawal symptoms if they stop taking the substance, or take it to prevent those withdrawal symptoms

Depending on how many of the above symptoms a person experiences, the substance use disorder may be described as:

Mild: two to three symptoms
Moderate: four to five symptoms
Severe: six or more symptoms

Signs your teen may have a substance use disorder

It can be difficult to determine whether your teen is acting differently because they’re simply going through adolescence or if they have developed a substance use disorder.

Still, there are some common signs to look for that may indicate a substance use disorder.

Changes in appearance

Most teens care about how they look. They may prefer a certain brand or style of clothing, or a specific haircut based on the latest trends.

But teens with a substance use disorder may not seem to care as much about their looks and choose to focus their attention more on the substance.

Changes in eating and sleeping habits

If your teen has developed a substance use disorder, you may notice that they eat or sleep too much or too little.

Some substances, like amphetamines, may make your teen feel as though they don’t need a lot of food or sleep. Others, like cannabis, may cause them to eat and sleep more than they did before.

Changes in their social group

Making new friends obviously doesn’t always mean something negative. But if your teen suddenly seems to surround themselves with a whole new group of people who greatly seem to differ in personality from their previous group of friends, it may be something to pay attention to.

If their old friends weren’t using drugs or alcohol, they may not fit in with your teen’s new lifestyle. So, your teen may begin to hang out with people who have the same interests and enjoy the same substances.

Lack of social activities

If your teen is no longer interested in playing sports or participating in the clubs they once enjoyed, a substance use disorder could be getting in the way.

Sometimes they’re no longer interested because substance use has become more important. Other times, it’s because they may feel embarrassed or wish to hide their substance use.

Other changes in behaviors

Everyone experiences changes in mood and behaviors from time to time, and teens are no exception. They can be moody and distant one day and warm and cordial the next.

But when your teen has developed a substance use disorder, changes in mood and behavior may be more severe, to the point where it seems to you that their entire personality has changed.

You may notice that they:

appear depressed or angry all of the time
ignore their chores or responsibilities
get annoyed more easily
get in trouble at school or with the police
have an overall negative attitude
have low self-esteem
lie, steal, or break curfew
show poor judgment
skip school or work
start arguments or physical fights
no longer study, and their grades have dropped

Who’s at risk?

Anyone can develop a substance use disorder, but certain situations or conditions can make someone more likely to try or misuse drugs or alcohol.

Risk factors based on early life

A person may be more likely to develop a substance use disorder if they:

were physically or sexually abused as a child
experienced another trauma as a child

Risk factors based on co-occurring conditions

Your teen’s risk of substance use disorder increases if they:

have one or more mental health conditions, such as anxiety, depression, or ADHD
use drugs or alcohol to manage their emotions

Risk factors based on family surroundings

Children may be more likely to develop a substance use disorder if:

their biological mother misused substances during pregnancy
one or both parents, or other close relatives, have a substance use disorder
the parents or other caregivers don’t actively discourage drug or alcohol use
they lack parental supervision
the parents or family don’t accept the teen’s sexual or gender identity

Risk factors based on school and peers

Social factors may also influence whether someone develops a substance use disorder. For example, a teen may start misusing substances if they:

don’t feel connected or motivated at school
don’t make good grades at school
have become friends with other teens who use substances
don’t have a lot of friends at school
are being bullied

When to see a doctor

It can be very hard and even scary to notice signs of a substance use disorder in your child — and it can be even harder for your teen. But being honest about what you’re seeing or experiencing is important.

If you believe your teen is experiencing more than one of the signs or symptoms of a substance use disorder, it’s best to make an appointment to speak with a doctor you and your teen trust.

This doctor could be a pediatrician or a mental health professional, such as a psychologist or a psychiatrist.

They will ask a series of questions that can help determine the level of the substance use disorder. They may also ask for your teen to give urine and blood samples.

Try to remind yourself and your teen that most healthcare professionals only want to help, not judge. Substance use disorder is a serious and challenging condition, not a sign of weakness.

Treatment for substance use disorder

If your teen needs treatment for their substance use disorder, their doctor or treatment team will create a customized program. It will be based on:

what substances they use
any other medical or mental health conditions they may have
any social problems they may have encountered

Both inpatient and outpatient programs are available. Some teens do better in an inpatient program where they stay at the treatment facility for some time.

Research has shown that the best treatment for teens is one that involves therapy with the entire family, as well as cognitive behavioral therapy (CBT) or a combination of therapeutic methods.

There are several new approaches that are now being used in addition to the traditional therapeutic model. Treatment may also include:

medications to help your teen taper off the substance
an exercise program
learning mindfulness techniques
learning about the harm of substance use

Tips for parents

While a lot of hard work may lie ahead for both of you, you can help your teen recover from a substance use disorder.

Once you have acknowledged that your teen may have a substance use disorder, you’ve taken the first step.

The next step is to approach your teen. Before you do, make sure you’re prepared. Here are some things you can do.

Talk it over with your partner or anyone who parents your teen

Make sure you both agree on what you’ll say and that you support each other during the conversation.

Agree not to yell. Discuss how you can approach your teen and best express your love and concern.

Be prepared for your teen to fight back

They may call you a hypocrite because they know you drink alcohol or have tried drugs before. You should be honest and explain that your use hasn’t harmed your life — or that it has, if that’s the case. Overall, keep the focus on your teen and your concerns.

If your teen becomes angry, try to stay calm. Fighting back with anger won’t help. Help them understand that you’re coming from a place of love.

Bring proof of your concerns

Gather anything you find that can support your concerns. It could be substances, devices like pipes, empty bottles, wrappers, etc. Still, be calm and factual when presenting your proof. Do not be accusatory or angry.

Plan the next steps before you talk

Determine what should happen next. Are you setting out rules for them to follow? Do you want to take them to a doctor? Let them know what will happen next, but also listen to and address their concerns.

Educate yourself

With this article, you’ve already made a first step toward educating yourself about teen substance use disorder and how to help your teen recover.

Still, many additional resources are out there, so consider learning more. Some options include:

Parents Guide from Drugs and Me
Parents: Facts on Teen Drug Use from the National Institute on Drug Abuse
Substance Use Resources for Parents of Adolescents and Young Adults from the Society for Adolescent Health & Medicine
Resources for Families Coping with Mental and Substance Use Disorders from the Substance Abuse and Mental Health Services Administration

Next steps

If you’re a teen and you feel like you can no longer control your substance use, consider finding someone to talk with. If you’re not yet comfortable talking with your parents, reach out to a teacher, school counselor, or other adult you trust.

You — or your parent — can also call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 800-662-4357. This is a free, confidential treatment referral and information service.

If you’re the parent, the first step is to review the signs and symptoms above. Then, make a plan to talk with your teen. If your teen has a substance use disorder, remember that help is available.

Once you’ve visited a doctor and received a diagnosis, a personalized treatment program can help your child overcome their substance use disorder.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Fadus MC, et al. (2019). Adolescent substance use disorder treatment: An update on evidence-based strategies. https://link.springer.com/article/10.1007/s11920-019-1086-0
Gray KM, et al. (2018). Research review: What have we learned about adolescent substance use? https://pmc.ncbi.nlm.nih.gov/articles/PMC5771977/
Katz-Wise SL, et al. (2017). LGBT youth and family acceptance. https://pmc.ncbi.nlm.nih.gov/articles/PMC5127283/
Mental health: What is a co-occurring disorder? (n.d.). https://teens.drugabuse.gov/drug-facts/mental-health
Most reported substance use among adolescents held steady in 2022. (2022). https://nida.nih.gov/news-events/news-releases/2022/12/most-reported-substance-use-among-adolescents-held-steady-in-2022
Nawi AM, et al. (2021). Risk and protective factors of drug abuse among adolescents: A systematic review. https://link.springer.com/article/10.1186/s12889-021-11906-2
Prepare to take action if you suspect teen or young adult drug use. (2017). https://drugfree.org/article/prepare-to-take-action/
Teens: Alcohol and other drugs. (2018). https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teens-Alcohol-And-Other-Drugs-003.aspx

This article originally appeared on PsychCentral. © 2025 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment.

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