Addressing substance use with adolescents with ADHD

Adolescence is a stage of life marked by numerous changes on various levels (biological, social, sexual, familial, cultural, etc.), full of ups and downs and complex moments. It is a critical period in which different problems can arise , depending on many factors such as personality, environment, culture, and life stage, which can affect a person's physical, mental, and emotional well-being.

Low self-esteem, bullying, eating disorders, unprotected sex, risky behaviors, family conflicts, substance abuse, technology addiction, and relationship difficulties are some of the problematic situations that can arise during adolescence. However , in the case of individuals with attention deficit hyperactivity disorder (ADHD), additional problems are added that they must face (and with greater intensity), which can affect their development and quality of life much more significantly than in other adolescents.

• Academic difficulties: They may have trouble concentrating, organizing, planning, and completing their schoolwork. They may also be easily distracted, forget instructions, or make careless mistakes. This can affect their performance, motivation, and self-esteem.
• Social problems : They may have difficulty relating to their classmates, teachers, and family members. They may be impulsive, talk too much, interrupt, or not respect turn-taking. They may also be perceived as immature, disrespectful, or disruptive. This can lead to rejection, isolation, or bullying.
• Emotional problems: They may experience intense and fluctuating emotions, such as anger, frustration, anxiety, or sadness. They may have difficulty regulating their emotions and expressing them appropriately. They may also have low self-esteem, feelings of guilt, or a lack of self-confidence.
• Behavioral problems : They may exhibit defiant, rebellious, or aggressive behavior toward authority or rules. They may act without considering the consequences, take unnecessary risks, or engage in illegal or dangerous activities. They may also be more likely to use psychoactive substances (drugs) or develop behavioral disorders.

It's important to understand how ADHD affects the brain and behavior in adolescence. It's a neurodevelopmental disorder that causes difficulties with attention, impulsivity, and executive functioning. These challenges can make it harder for teens with ADHD to connect their actions with consequences, regulate their emotions and impulses, plan ahead, resist temptation, and cope with stress and frustration. They may also be misunderstood, rejected, or labeled as "the one who talks nonsense," among other things.

ADHD and problematic substance use in adolescence

Studies have shown an increased risk of substance use and addiction among people with ADHD , who are more likely to experiment with drugs and alcohol, start using them at a younger age, use them more frequently and in higher doses, and develop substance use disorders than people without ADHD. Some of the contributing factors include:

• Curiosity: People with ADHD in adolescence may be more curious and adventurous and may seek novel and stimulating experiences through substance use.
• Peer pressure: They may have difficulties with social skills and relationships with their peers, and may use substances to fit in, impress others, or avoid rejection.
• Impulsiveness: They may act on their impulses without thinking about the consequences, and may have trouble saying no to offers or opportunities to use substances.

Therefore, in addition to information and training in the classroom, it is important that we communicate with our sons and daughters to explain the dangers and consequences of substance use and addiction in a clear, honest and respectful way.

People with ADHD are more likely to experiment with drugs and alcohol, to start using them at a younger age, more frequently, and in higher doses.

What signs might indicate that my son or daughter may have a substance use problem?

- Changes in mood, behavior, or appearance :

• Losing interest in activities that I used to enjoy.
• Leaving old friendships for a new group.
• To act with dejection, aggression, or anger.
• Sleeping more than usual.
• Break the rules.
• Exhibit physical changes such as sudden weight loss, frequent nosebleeds, bloodshot or watery eyes, or tremors.

- Difficulties with attention, impulsivity, and executive functioning, with problems in:

• Connect your actions with the consequences.
• Regulate your emotions and impulses.
• Plan ahead.
• Resist temptations.
• Dealing with stress and frustration.

- Problems with school performance and attendance:

• Suspend exams and quizzes.
• Getting bad grades in classes.
• Skipping class or school without your approval.

- Evidence of substance use or possession :

• Finding drugs, alcohol, suspicious utensils, or prescription medications in their room or backpack.
• Smelling of alcohol or marijuana on their breath or clothes.
• Noticing that money or valuables are missing from the house.

The relationship between ADHD and substance use disorder

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How can I talk to my son or daughter about their substance use?

If you suspect or know for sure that your son or daughter has a substance use problem, it is important to seek professional help as soon as possible. Substance use can have serious and lasting effects on a person's physical, mental, and emotional health, as well as their academic, social, and personal development.

Some tips for addressing the topic:

- Get informed and offer accurate information

• Learn about the effects of different substances on the brain and body, the signs and symptoms of substance use and addiction, and the treatment options available.
• Use reliable sources of information, such as websites of accredited organizations or books by experts in the field.
• Explain to your son or daughter the facts about substance use and its effects on their health, well-being, and future.
• Use examples that are relevant to their age, interests, and goals.
• Avoid exaggerating or minimizing risks.
• Be honest about your own knowledge and experience.

- Start addressing this issue as soon as possible: Don't wait until you suspect there's a problem. Talk about it before they're exposed to peer pressure or temptation.

- Use good times and places for conversation :

• Look for opportunities to bring up the topic naturally, such as when you see or hear something related to substance use in the media, in your community, or in your family.
• Ask him what he thinks or knows about it, and share your thoughts and feelings.
• Find a quiet, private moment when you are not busy, distracted, or under the influence of any substances.
• Avoid starting the conversation when you are angry, worried, or tired.

Listen actively, respectfully, and with understanding. Keep the conversation going.

• Show interest and empathy when he talks to you.
• Avoid interrupting, judging, lecturing, or criticizing.
• Ask open-ended questions that encourage them to express their opinions, feelings, and concerns.
• Validate their perspective and acknowledge their challenges.
• Show him or her that you care about him or her and that you want to help.
• Use a friendly and compassionate tone, and avoid blaming, shaming, or threatening him.
• Acknowledge their feelings and opinions, and listen to what they have to say.
• Don't make this a one-time conversation.
• Communicate regularly and show interest in their progress and challenges.
• Be open and honest, and maintain a relationship of trust.

- Provide accurate and relevant information about the risks and harms of substance use and addiction and use meaningful examples of how substance use can affect their health, goals, relationships, or future.

- Set expectations :

• Establish clear rules and limits on substance use in the family, explaining the reasons for these rules and the consequences of breaking them.
• Tell him or her what you expect regarding substance use and what will happen if he or she breaks the rules.
• Be clear and consistent, and deal with the consequences.
• Praise their positive behaviors and achievements, and reward their efforts to change.

- Offer support and encourage them to seek help:

• Let her know that you're always there if she needs help or advice.
• Praise their strengths and achievements.
• Help him find healthy ways to deal with stress, boredom, or negative emotions.
• Encourage him to pursue his interests and hobbies.
• Offer or connect them with positive role models and mentors.
• Show them they are not alone and that there are many resources and professionals who can help them overcome their substance use problem. Different types of treatment options are available for teenagers with substance use problems, depending on the severity of their condition, the type of substance they use, and their individual needs and preferences.

Does family communication influence adolescent development?

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What should I do if my child refuses to talk about their substance use?

Your teenage son or daughter may find it difficult to talk about this issue and may refuse to do so. In this situation, some tips can help you address the problem:

• Respect their privacy and autonomy: They may not want to talk about their substance use because they feel ashamed, scared, or angry. They may also feel like you're invading their personal space or trying to control their life. Try to respect their feelings and boundaries, and avoid snooping, spying, or forcing them to talk. Instead, let them know you care and are available when they want to talk, using a supportive and non-threatening tone.
• Be patient and persistent: They may not be able to talk about their substance use right away. They may need some time to process their situation and emotions, or to realize the negative consequences of their behavior. Don't pressure them or expect immediate results. Instead, be patient and persistent in showing your interest and support. Keep the lines of communication open and look for opportunities to bring up the topic gently and respectfully.
• Seek professional help: If he refuses to talk to you about his substance use, he may be more willing to talk to a trained professional with experience in treating this problem. You can check with your primary care doctor, mental health professionals, or substance abuse specialists for advice and referrals. You can suggest that he try talking to a professional and offer to go with him or help him schedule an appointment.
• Join a support group: You are not alone in this. There are many other parents going through similar challenges who can offer support and guidance. You can join a support group or an online community where you can connect, share your experiences and feelings, and learn from one another. You can also encourage your child to join a support group for teens struggling with substance use, where they can meet others who understand what they are going through and who can motivate them to change.

How can I prevent my son or daughter from using substances?

- Create a strong and positive relationship .

• Show him or her that you care about him or her, that you feel respect and trust.
• Spend quality time together and share your values and expectations.
• Offer your support so that they can achieve their goals and interests, and overcome their challenges.

- Speak openly and honestly about substance use.

• Provide accurate and relevant information about the risks and consequences of using different substances, and the benefits of staying away from them.
• Use teaching moments, such as news stories, movies, or personal experiences, to start the conversation.
• Listen to their opinions and questions, and respond to them respectfully and objectively.
• Avoid lectures, scolding, and threats.

- Establish clear and consistent rules and limits on substance use in the family .

• Explain the reasons for your rules and the consequences of breaking them.
• Be firm and fair in enforcing them, and follow through with the consequences.
• Praise and reward the effort of following the rules and making healthy choices.

- Monitor your son or daughter's activities and relationships . This isn't about being a police officer or policing their life, but rather about understanding their interests.

• Find out who their friends are, where they go, what they do, and how they spend their money.
• Get involved in his school and extracurricular activities, and encourage him to participate in the positive ones.
• Help him find alternatives to substance use, such as sports, hobbies, volunteering, or other interests.

- Be a good role model.

• Avoid using substances, or do so in moderation and responsibly.
• Do not provide them with substances (or their friends), and do not allow them to use substances in your home or under your supervision.
• Do not make jokes or positive comments about substance use, and do not offer them in any way.
• Show them how to deal with stress, boredom, or negative emotions in a healthy way.

Seek professional help if needed. If you suspect or confirm that your son or daughter has a substance use problem, don't hesitate to seek professional help as soon as possible.