Substance Use Disorders in Children and Adolescents

ICD-10 code: F19.10

Substance use disorders are grouped within the cluster of diagnoses called the substance-related and addictive disorders. Substance-related and addictive disorders are characterized by a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the use of substances. These problems are persistent and occur repeatedly within the same 12-month period.

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The term substance can refer to a drug, a medication, or a toxin. In addition to alcohol, types of substances to which individuals may become addicted include:

  • Tobacco
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Stimulants

Substance-related disorders are divided into two groups:

  • Substance use disorders (SUD)
  • Substance-induced disorders—intoxication, withdrawal, and other substance/medication-induced metal disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders).

The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. An important characteristic of this disorder is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral effects of these brain changes may be exhibited in the repeated relapses and intense drug craving when the individuals are exposed to drug-related stimuli.

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What is substance use disorder?

Substance abuse continues to be one of the most common and serious mental health disorders, with 35% lifetime prevalence in American society. 30-50% of Substance Use Disorders begin in childhood or adolescence. By the end of high school, almost half of adolescents have abused an illicit drug at least once.

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  • Overall, the diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to use of the substance.
    • Increased usage- The substance is often taken in larger amounts or over a longer period than was intended
    • Unsuccessful Discontinuation- There is a persistent desire or unsuccessful efforts to cut down or control substance use
    • Time- A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects
    • Craving- Craving, or a strong desire or urge to use substance
    • Impact on Daily Living- Recurrent substance use resulting in failure to fulfill major role obligations at work, school or home.
    • Interpersonal Problems- Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substance
    • Social Activities- Important social, occupational, or recreational activities are given up or reduced because of substance use
    • Physically Hazardous- Recurrent substance use in situations in which it is physically hazardous
    • Psychological/Physical Impact-Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
    • Tolerance- A need for markedly increased amounts of the substance to achieve intoxication or desired effect
    Withdrawal- characteristic withdrawal syndrome for specific substance; substance is taken to relieve withdrawal symptoms
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Understanding Substance Use Disorder

The continuum of child and adolescent substance use ranges from non-users, through experimental and casual users, to substance use and induced disorders. Genetics appear to play a role in the development of substance use disorders.

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Children of substance abusers appear to be particularly vulnerable to adolescent drug use, likely resulting from genetic and family dynamic factors with learned attitudes toward substance abuse. The age in which an individual begins to use substances has been shown to be a strong predictor for the development of substance use disorders over the lifetime. Peers are influential and mediate the avoidance of drugs, as well as both the initiation and maintenance of substance abuse. Several cognitive factors determine substance use and are often specific to each drug. This is usually related to the perceived risks and benefits associated with using the substance. There are several psychological factors that impact a young individual's experience with substances. This includes whether they use the substance to produce positive feelings and avoid unpleasant ones, relieve tension and stress, reduce disturbing emotions, alleviate depression and anxiety, and gain peer acceptance.

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How is SUD treated?

SUD is treatable and should be matched relative to the severity and intensity of the substance use. If a patient is experiencing severe problems resulting from use, toxicity may require medical monitoring. Thus, intensive inpatient and/or residential treatment are necessary before considering behavioral interventions.

Published treatment guidelines for SUD include those from the National Institute of Drug Abuse and the Society of Clinical Child Psychology.

First Line Treatments

  • Cognitive-behavioral therapy - The person would examine thought patterns during, before, and after the use of any substance. The clinician using CBT would help the person identify these thoughts and realize the connection they have to the resulting substance use. The person is then taught other coping behaviors to use instead of substance use.
  • Family-based treatment- Family therapy addresses the factors associated with serious antisocial behavior in children and adolescents who abuse drugs. These factors include characteristics of the adolescent, family conflict, peer, school, and neighborhood.

Second Line Treatments

In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:

  • Motivational Interviewing/Motivational Enhancement Therapy (MET)

  • Family based treatment- behavioral

  • Combined MET/CBT/family-based treatment and Contingency Management

  • Combined family-based treatment-ecological and Contingency Management

  • Outpatient treatment or residential "day" facilities

  • Assertive Continuing Care (ACC)

Third Line Treatments

When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:

  • Drug Counseling/12 Step Programs
  • Recovery High Schools
  • Peer Recovery Support Services
  • Addiction Medications for Opioid Use
    • Buprenorphine
      • Not recommended for pediatric patients under the age of 16
    • Methadone
    • Naltrexone
  • Addiction Medications for Nicotine Use Disorders
    • Bupropion
    • Varenicline
    • Nicotine Replacement Therapies (NRT)

Published treatment guidelines for SUD include those from the National Institute of Drug Abuse and the Society of Clinical Child Psychology.

First Line Treatments

Second Line Treatments

In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:

Third Line Treatments

When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:

Substance Use Disorder & Withdrawal – Signs, Symptoms, and Treatment

Withdrawal happens when a person feels physically and emotionally unwell, and using substances again seems like the only way to feel better.
This video from Psych Hub explains the signs and symptoms of substance use disorder (SUD) and highlights treatment options that can support recovery.

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Psych Hub is an educational service. The information provided in this video is not a substitute for professional advice, diagnosis, or treatment. If you believe you or someone you know may be experiencing mental health symptoms, please seek help from a qualified medical or behavioral health professional.

If you or someone you know is in immediate danger, call 911 (U.S.).