Substance Use Disorders

Overview & Risk Factors - Teen Temptations

• Substance Use Disorder (SUD): Pattern of substance use leading to impairment or distress.
• Common substances: Tobacco, alcohol, cannabis, opioids (e.g., heroin, cough syrups), inhalants (e.g., glue, whiteners).
• Adolescence: Critical period for initiation; brain still developing.
• Risk Factors:
  • 📌 RISK Mnemonic:
    • Relatives: Family history of SUD, parental substance use, permissive attitudes.
    • Instability: Family conflict, poor parental monitoring, low socioeconomic status, abuse/neglect.
    • School failure: Academic difficulties, truancy, disengagement.
    • Kids using: Peer pressure, social normalization, desire for experimentation.
  • Co-occurring psychiatric disorders (ADHD, depression, anxiety).
  • Early trauma or significant stress.

⭐ Early age of initiation (typically <15 years) of substance use is a major predictor of developing severe SUD and other comorbidities.

Screening & Diagnosis - Spotting the Signs

• Universal Screening: Key for early identification in all adolescents.
• Screening Tools:
  • 📌 CRAFFT: Car, Relax, Alone, Forget, Friends/Family, Trouble. Score ≥2 = Positive. Recommended for adolescents.
  • ASSIST: WHO tool; screens multiple substances (alcohol, tobacco, illicit drugs).
  • AUDIT-C: Alcohol specific (3 questions). Score ≥3 (Females), ≥4 (Males) = At-risk drinking.
  • DAST-10: Drug Abuse Screening Test (10 items).
• Clinical Clues (Red Flags):
  • Physical: Weight changes (↓/↑), poor hygiene, track marks, recurrent epistaxis.
  • Behavioral: ↓ school performance, secretive behavior, new peer group, legal issues.
  • Psychological: Mood swings, irritability, anxiety, depression, memory problems.
• Diagnosis: Based on DSM-5 criteria for Substance Use Disorder (SUD).

⭐ The CRAFFT questionnaire (Car, Relax, Alone, Forget, Family/Friends, Trouble) is a validated and widely recommended mnemonic-based screening tool for adolescent substance use; a score of ≥2 is positive.

Key Substances & Effects - Perilous Poisons

Commonly abused substances by adolescents include:

Management & Prevention - Guiding Recovery

• Goal: Abstinence or harm reduction, improved overall functioning.
• SBIRT Model: Screening, Brief Intervention, Referral to Treatment.

• Brief Interventions (BI):
  • Utilize 📌 FRAMES model: Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy.
• Motivational Interviewing (MI):

  • ⭐ Motivational Interviewing (MI) is a key evidence-based psychotherapeutic approach for adolescents with SUD, focusing on enhancing intrinsic motivation to change behavior.

• Psychosocial Therapies:
  • Cognitive Behavioral Therapy (CBT), family-based therapies (e.g., MDFT), contingency management.
• Pharmacotherapy (Adjunctive & Cautious):
  • Naltrexone (AUD, OUD); Buprenorphine (OUD - specialist care). Prioritize treating co-occurring psychiatric disorders.
• Prevention: Universal (e.g., school programs), Selective (for at-risk youth), Indicated (for those with early signs).

High‑Yield Points - ⚡ Biggest Takeaways

• CRAFFT is the key screening tool for adolescent substance use.
• Alcohol, tobacco, cannabis are most common; inhalants in younger teens.
• High comorbidity with mental health disorders (e.g., depression, ADHD).
• Confidentiality is vital, but safety concerns (harm to self/others) are exceptions.
• Brief interventions & motivational interviewing are effective initial strategies.
• Early use of gateway drugs (alcohol, tobacco) ↑ risk of other illicit drugs.
• Family involvement is crucial for prevention and treatment success.