What is a substance use disorder?

Tim Wilens, MD
Tim Wilens, MD

A substance use disorder (SUD) is a pattern of using drugs, alcohol or other substances that affects a person’s daily life and activities. SUD used to be called substance abuse, drug abuse, drug dependence or alcohol dependence. At MassGeneral Hospital for Children (MGHfC), we now call it SUD because it is less judgmental or negative. It also helps people understand that SUD is a disorder, not a character or moral problem.

SUD is a brain-based disorder. This means there are differences in the brains of people who do and do not have an SUD. We think some of the brain differences can either lead to an SUD or might a result of SUD.

When does substance use become a problem?

Substance use becomes a problem when drugs or alcohol start to control your child instead of your child controlling the drugs or alcohol.

What are the signs of SUD in teens and young adults?

  • Problems at school or work
  • Poor grades in school
  • Not using other medications correctly
  • Changes in personality, behavior or mood
  • Spending more money than usual
  • Finding that money is missing
  • Not keeping up with personal hygiene and cleanliness
  • Hanging out with a different group of friends
  • Coming in late without reasonable explanations

What are the risk factors for SUD?

  • Family history of an SUD. Children with parents who have an SUD are 2-4 times more likely to also develop an SUD. A parent with SUD who uses substances at important times of the child’s life (like the early teen years) places their child at very high risk for also developing an SUD.
  • Genetics. About half of all SUDs come from genetics. The other half comes from the environment your child is raised in. For example, even if an SUD runs in your family, but your child never uses drugs or alcohol, he will not develop an SUD.
  • Community. There are many factors in your community that play a role in whether your child develops an SUD. This includes availability of drugs or alcohol; your family and community’s values and attitudes toward substance use; your family’s experiences with substance use; and the number of people in your community who have an SUD.
  • Behavioral health disorders. This includes anxiety, depression and attention-deficit hyperactivity disorder (ADHD). Children with mood or behavioral disorders are more likely to develop an SUD later in life. Treatment of these disorders helps lower the chances of your child developing an SUD later in life.

Why do teens and young adults misuse drugs or alcohol?

  • Perception
    Many teens and young adults think prescription drugs are not dangerous, illegal or addictive. They believe you can misuse prescription drugs responsibly. They also believe their families do not know when they use prescription drugs. Eight (8) out of every 10 high school seniors use prescription painkillers (narcotics). Of those 8 seniors, 4 say it is easy to get prescription painkillers from family.
  • Low self-esteem
    Many teens and young adults who have an SUD also have low self-esteem. The SUD and low self-esteem can feed into one another.
  • Dynamics
    Some teens and young adults use drugs or alcohol to cope with their problems or when something is bothering them. Drug and alcohol use in families can also affect whether teens and young adults develop an SUD later in life.

When should I start talking to my child about drugs and alcohol?

Start talking to your child about drugs and alcohol when they are in 5th or 6th grade. Many families worry that this is too early, but this is not true. Almost half of SUDs start before age 18. Many teens first try drugs or alcohol around age 12.

What makes SUD treatment successful?

  • Have your family involved. When treating an SUD, including the family is very important to support the person in treatment and one another.
  • Find out why your child uses drugs or alcohol. This is also called motivational enhancement. By finding out why your teen uses drugs or alcohol, you can help find the right treatment.
  • Take a harm reduction approach. One of the best ways to help your child is to help them slowly lower their substance use over time. If they quit too quickly, they are more likely to have withdrawal symptoms or relapse (start using substances again).
  • Improve coping skills. This means working with your child to find out what triggers their substance use (like anger or anxiety) and learning new ways to cope. This can include relaxation skills, anger management or finding ways to solve problems in relationships.
  • Find a therapist or psychiatrist. This is helpful if your child is struggling with anxiety, depression or other disorders. Call Child and Adolescent Psychiatry at MGHfC at 617-724-5600 to find a therapist. MGHfC and Massachusetts General Hospital also have a specialty service for young people with SUD (age up to 26 years) called the Addiction Recovery Management Service (ARMS). Call ARMS at 617-643-4699.

How can I safely store my prescription medications?

  • Get rid of old or expired medications. Check if your local pharmacy or police station has a drug take back program. If your town does not have a drug take back program, crush the old medications and mix them with something unpleasant, like cat litter or used coffee grounds, before throwing them away.
  • Keep prescription medications in a sock drawer or underwear drawer. This is where people are least likely to look for medications. Do not store prescription medications in a medicine cabinet.
  • If you use opioids, learn how to safely use, store and get rid of prescription opioids here.

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