Substance use disorder is a disease that affects not only the person with the disorder, but their entire family, friends and communities. Substance use occurs along a continuum or spectrum. It ranges from no use of drugs or alcohol to limited, regular or problematic use. Substance use disorder occurs when a person’s use of drugs or alcohol interfere with their ability to carry out their daily activities, such as work or school. It can also cause serious health concerns or, in some cases, overdose and death. In this Q&A, Amy Yule, MD, medical director of the Addiction Recovery Management Service (ARMs) at Massachusetts General Hospital shares tips on how to spot signs of substance use disorder in teens and young adults. She also shares tips on how to support your child if they do struggle with substance use disorder and common treatments.

Did You Know...?

Doctors do not use the terms abuse or dependence when talking about substance use. These words have a stigmatizing or negative tone that can lead to feelings of shame or blame. The term substance use disorder allows the disease to be seen as a medical condition that is separate from the person.

What Are the Risk Factors for Substance Use Disorders?

  • How the teen brain develops (The brain develops back to front. The frontal cortex, or front part of the brain that helps with decision-making, develops last.)
  • Family history
  • Family conflicts or stress in the home
  • Trouble in school
  • Access to substances in the home or community
  • Early substance use
  • Psychiatric illness (such as ADHD, oppositional defiance disorder, depression or anxiety)

What Are the Signs of Substance Use Disorder?

  • Behavioral changes
  • Withdrawal from family and friends
  • Poor performance in school
  • Change in friend groups
  • Loss of interest in favorite activities
  • Trouble controlling use of the substance
  • Risky situations with no regard for consequences
  • Signs of tolerance or withdrawal

How Can I Lower My Child's Risk of Substance Use Disorder?

  • Set clear expectations for substance use. Decide on clear consequences and follow through on them if your child does use substances.
  • Keep clear lines of communication open at all times. This can help your child feel more comfortable talking to you about concerns around substance use, stress, school or other concerns.
  • Get to know your child’s friends, peer groups, their families and where they spend time together.
  • If there is a history of a substance use disorder in your family, talk with your child about this so they know they are at increased risk to develop a substance use disorder.
  • Have your child participate in positive social activities that do not involve substance use, such as exercise or sports.

How Do Doctors Treat Substance Use Disorders?

Many teens and young adults do not receive treatment for substance use disorder. In many cases, there is a stigma (when someone views you in a negative way because of a certain trait, feature, decision or behavior) against people who have substance use disorders. In other cases, some teens and young adults do not see their substance use disorder as a problem. They might also not see themselves at risk for developing or having a substance use disorder. Most people seek help for their substance use disorder when there is an issue at home or in school. They might also seek help if they have legal issues or mental health concerns.

Common treatments include:

Teens and Young Adults

  • Adolescent community reinforcement approach. This behavioral intervention (treatment) helps your child replace substance use with positive social activities and behaviors that support recovery.
  • Motivational interviewing to help teens and young adults identify reasons to motivate them toward recovery.
  • Therapy for improved communication, problem-solving skills and ability to cope with emotionally challenging situations or thoughts.
  • Medications to treat mental health concerns.


  • Community reinforcement and family training. This is a type of therapy for caregivers on how to help motivate your child to come to treatment and decrease their substance use.

Treatment is unique to each person and their symptoms and needs. The care team can help you and your child decide which treatments might work best. At MGfC, doctors believe substance use disorder affects the whole family, not just the person with the disorder. Teens or young adults and their families will receive various treatments from different providers. Treatment usually includes a combination of medications, therapy, peer support and family involvement.

Where Can I Learn More About Substance Use Disorder?

The ARMS Clinic at Mass General is an outpatient, dual diagnosis clinic with a multidisciplinary team of clinical psychiatrists, psychologists and masters-level social workers who care for teens and young adults ages 14-26 who struggle with substance use disorders and their families. They provide care for substance use disorders and mental health, monitor patients’ progress and assist with relapse. They can also help patients and families navigate the treatment system.

Rev. 5/2019. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.