Key points

• Family risk of substance use, ACEs, and early age of use increase a teen’s risk of problematic substance use.
• Nicotine and cannabis are widely available and high potency, raising concerns for toxicity and dependence.
• Parents can monitor for common reasons teens self-medicate (anxiety, sleep, attention) and address these.
• Cultivating supportive relationships can serve as a protective factor.

Risk-taking and testing limits are a regular part of adolescent development. Many teens experiment with drugs, alcohol, or over-the-counter substances during this period. While the desire to experiment isn’t new, the landscape of substance use has changed dramatically for today’s parents.

1. Rates of Substance Use among Teens are Down

Teen substance use has fallen to some of the lowest levels in the last three decades. In 2000, 40.9% of U.S. 12th graders reported using an illicit drug in the past year; by 2024, that dropped to 26.2% (1). Excluding marijuana, only 6.5% reported using any illicit substance—down from 20.4% in 2000 (2).

2. Overdose Deaths Have Increased

Despite lower use overall, teen overdose deaths have risen sharply since 2020, driven mainly by counterfeit pills laced with fentanyl, a potent opioid (3, 4). Social media platforms serve as easy-access online drug marketplaces for underage users (5). A teen seeking a stimulant or anti-anxiety pill may unknowingly purchase a counterfeit drug, risking a fatal overdose. While overdose deaths remain far less common among adolescents than adults, rates have not returned to pre-pandemic levels. Naloxone nasal spray, an opioid reversal agent, is now available over the counter in all 50 U.S. states (6).

Parent tip: Discourage use of substances obtained online due to the risk of fentanyl contamination.

3. Cannabis Is More Potent

Marijuana is now legal for medical use in 47 states and for adult recreational use in 24. Modern cannabis products—vapes, edibles, oils, tinctures, and concentrates—contain far higher levels of THC (the main psychoactive ingredient) than in past decades.

Higher-potency THC has been linked to dependence, poorer cognitive outcomes, and, for those with a family history of schizophrenia, a risk of psychosis (7–9). Even moderate use can increase risk (10). Despite this, teens’ perception of marijuana’s risk has declined significantly (11).

Parent tip: Educate your teen about modern THC products, which are much more potent and carry higher risks of intoxication and dependence.

4. Family History as a Risk

Genetics accounts for about 50% of the risk for developing a substance use disorder (SUD) (12). Large-scale genome-wide association studies (GWAS) show that many genes influence addiction, and a single gene can affect multiple traits (pleiotropy). For example, some genes influence not only SUD risk but also other psychiatric conditions, such as ADHD and anxiety (13–15). These shared pathways may explain why mental health challenges and substance use often co-occur. Many identified genes affect brain circuits tied to reward, learning, and impulse control, forming an overlapping biological foundation across types of addiction.

Parent tip: Discuss family history of SUD as you would any other heritable condition—this empowers informed decisions.

5. Early Exposure to Substances Increases Risk

Starting substance use early—especially alcohol, nicotine, or cannabis—increases the likelihood of addiction later in life (16, 17). In one study, each additional year of delayed onset reduced the odds of dependence by 14% and abuse by 8% (16).

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Adolescents are biologically more vulnerable: the prefrontal cortex (responsible for judgment and impulse control) is still maturing, while reward pathways are hypersensitive. Substances can disrupt key neurodevelopmental processes—such as synaptic pruning and myelination—that strengthen and refine brain wiring. Disruption can affect learning, emotional regulation, and memory.

Parent tip: Emphasize that delaying substance use lowers the lifetime risk of addiction, especially for youth with a family history of SUD.

6. ACEs and PCEs

Adverse Childhood Experiences (ACEs)—such as abuse, neglect, or household dysfunction—have a strong, dose-dependent link to adult substance use disorders (18, 19). The more ACEs a person experiences, the higher their risk.

Conversely, Positive Childhood Experiences (PCEs)—safe, stable, and nurturing relationships—can buffer this risk. Research shows that PCEs foster resilience and mitigate the long-term effects of adversity (20, 21).

Parent tip: Cultivating stable, supportive relationships provides powerful protection against future substance misuse.

7. Nicotine and Other OTC Products

While cigarette smoking among teens has plummeted, newer nicotine products—especially pouches and vapes—are increasingly popular (22). Concentrations of nicotine in pouches can far exceed those in traditional cigarettes, raising concerns for dependence and toxicity. TikTok’s “Zynfluencers” have fueled their appeal (23). Long-term health outcomes remain unclear.

Teens also have access to a growing range of unregulated products sold at gas stations, vape shops, and online. Many have deceptive, youth-oriented packaging. Examples include:

• Delta-8 THC, a psychoactive compound derived from hemp and similar to Delta-9 THC, is sold as gummies or vapes (24).
• Kratom, a plant-derived substance that acts as a stimulant at low doses and a sedative at high doses. It’s sold as tea, capsules, or extracts and is regulated in only some states (25).

Both substances can have unpredictable potency and health effects. Though the legal purchase age in the U.S. is 21, enforcement may be inconsistent.

Parent tip: Ask your teen if they’ve seen online ads for nicotine, cannabis derivatives, or other “natural” products, and provide accurate information about risks.

8. Binge Drinking

Alcohol remains the most common substance used by teens, often consumed in binge patterns—multiple drinks in a short period. Binge drinking raises the risk of sexual assault, risky sexual behavior, accidents, and injuries (26).

Parent tip: Review potential health risks and model healthy behavior—drink in moderation, avoid using alcohol to cope with stress, and never drive after drinking.

9. Self-Medication

Teens may turn to substances to manage anxiety, low mood, sleep problems, or inattention. Self-medicating can be a path to dependence and abuse. Addressing these symptoms early through a multidisciplinary approach, including pediatric, mental health, and school support, can reduce the risk.

Parent tip: Monitor sleep, stress, focus and social connection; these protective factors lower the likelihood of substance misuse.

References

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6.https://www.cdc.gov/stop- overdose/caring/naloxone.html#:~:text=Where%20can%20you%20get%20naloxone,buy%20naloxone%20over%20the%20counter. Accessed November 4, 2025.

7. Austin-Zimmerman I, Spinazzola E, Quattrone D, et al. The impact of schizophrenia genetic load and heavy cannabis use on the risk of psychotic disorder in the EU-GEI case-control and UK Biobank studies. Psychological Medicine. 2024;54(15):4160-4172. doi:10.1017/S0033291724002058.

8. Hall W, Degenhardt L. Cannabis use and the risk of developing a psychotic disorder. World Psychiatry. 2008;7(2):68-71. doi: 10.1002/j.2051-5545.2008.tb00158.x.

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10. Ho BC, Barry AB, Koeppel JA, Macleod J, Boyd A, David A, O’Leary DS. Recreational Marijuana Use, Adolescent Cognitive Development, and Schizophrenia Susceptibility. Biol Psychiatry Glob Open Sci. 2022 Feb 8;3(2):222-232. doi: 10.1016/j.bpsgos.2022.01.008.

11. Miech, R. A., Johnston, L. D., Patrick, M. E., & O’Malley, P. M. (2025). Monitoring the Future national survey results on drug use, 1975–2024: Overview and detailed results for secondary school students. Monitoring the Future Monograph Series. Institute for Social Research, University of Michigan.

12. Deak JD, Johnson EC. Genetics of substance use disorders: a review. Psychol Med. 2021 Oct;51(13):2189-2200. doi: 10.1017/S0033291721000969.

13. Gerring, Z.F., Thorp, J.G., Treur, J.L. et al.). The genetic landscape of substance use disorders. Mol Psychiatry 29, 3694–3705 (2024). https://doi.org/10.1038/s41380-024-02547-z.

14. Miller AP, Bogdan R, Agrawal A, Hatoum AS. Generalized genetic liability to substance use disorders. J Clin Invest. 2024 Jun 3;134(11):e172881. doi: 10.1172/JCI172881.

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16. Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse. 1997;9:103-10. doi: 10.1016/s0899-3289(97)90009-2.

17. Hinckley JD, Ferland JN, Hurd YL. The Developmental Trajectory to Cannabis Use Disorder. Am J Psychiatry. 2024 May 1;181(5):353-358. doi: 10.1176/appi.ajp.20231006.

18. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–258. doi:10.1016/S0749-3797(98)00017-8.

19. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356-e366. doi:10.1016/S2468-2667(17)30118-4.

20. Graupensperger S, Kilmer JR, Olson DCD, Linkenbach JW. Associations Between Positive Childhood Experiences and Adult Smoking and Alcohol Use Behaviors in a Large Statewide Sample. J Community Health. 2023 Apr;48(2):260-268. doi: 10.1007/s10900-022-01155-8.

21. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019 Nov 1;173(11):e193007. doi: 10.1001/jamapediatrics.2019.3007.

22. Dai HD, Leventhal AM. Prevalence of Nicotine Pouch Use Among US Adults. JAMA. 2024;332(9):755–757. doi:10.1001/jama.2024.10686.

26. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics. 2007 Jan;119(1):76-85. doi: 10.1542/peds.2006-1517.