Substance Use Disorder (SUD) in Child & Adolescent Populations

A Guide for Primary Care Providers, Mental Health Professionals, and Families in Nevada and Beyond

What is Substance Use Disorder?

Substance Use Disorder (SUD) is a chronic but treatable medical condition characterized by the recurrent use of alcohol or drugs despite harmful consequences. In children and adolescents, substance use exists on a spectrum from experimentation to risky use to SUD. While experimentation may occur during adolescence, repeated use, increasing frequency, impaired functioning, inability to stop, or continued use despite negative consequences may indicate a developing SUD.

Adolescence is a critical period of brain development. The regions of the brain responsible for judgment, impulse control, decision-making, and emotional regulation continue developing into the mid-20s. Exposure to alcohol, nicotine, cannabis, prescription medications used non-medically, or illicit drugs during this time can interfere with normal brain development and increase the risk of long-term physical, mental, academic, and social consequences.

The encouraging news is that SUD is treatable, especially when identified early. Primary care providers (PCPs) play a vital role in prevention, early identification, brief intervention, and connecting youth and families with evidence-based treatment and community resources.

SUD Quick Facts

Approximately 1 in 10 Nevada adolescents (ages 12–17) meets criteria for a Substance Use Disorder each year. (source)
Adolescents who begin using substances at an earlier age are at greater risk of developing SUD later in life. (source)
The American Academy of Pediatrics (AAP) recommends routine substance use screening during adolescent preventive visits (AAP Clinical Report. (source)
Early intervention and family involvement improve treatment outcomes and long-term recovery. (source)

How Common is Youth Substance Use?

Substance use among adolescents remains an important public health issue, although recent national trends show encouraging declines in many substances.

According to the 2023 CDC Youth Risk Behavior Survey (YRBS), approximately 22% of U.S. high school students reported current alcohol use, 17% reported current marijuana use, and e-cigarettes remain the most commonly used tobacco product among youth. Overall, cigarette smoking and several other forms of substance use have declined substantially over the past decade.

Nevada has experienced similar improvements. The 2024 Nevada Epidemiologic Profile found decreases between 2021 and 2023 in adolescent alcohol use, nicotine vaping, marijuana vaping, and cigarette smoking. Despite this progress, substance use continues to affect thousands of Nevada youth each year, reinforcing the importance of prevention and early intervention.

Risk and Protective Factors

Substance Use Disorder develops through a combination of biological, psychological, family, and environmental influences. No single factor causes SUD.

Risk factors may include:

Family history of substance use disorders
Depression, anxiety, ADHD, trauma, or other mental health conditions
Adverse Childhood Experiences (ACEs)
Peer substance use
Poor parental monitoring or family conflict
Academic difficulties
Easy access to alcohol, nicotine, cannabis, or prescription medications

Protective factors include:

Strong parent-child relationships
Consistent family communication and supervision
Positive peer relationships
School connectedness
Participation in sports, clubs, or other extracurricular activities
Healthy coping skills
Access to behavioral health care when needed

Co-Occurring Mental Health Conditions

Substance use and mental health conditions frequently occur together in children and adolescents. Depression, anxiety disorders, ADHD, trauma-related disorders, eating disorders, and suicidal thoughts or behaviors may contribute to substance use or become worse because of it.

When substance use is identified, PCPs should also assess for co-occurring behavioral health conditions (such as depression, anxiety, ADHD, trauma, and suicidality) and other safety concerns. Because mental health conditions and substance use disorders frequently occur together, integrated assessment and treatment generally produce better engagement and clinical outcomes than treating either condition in isolation. (source)

Signs and Symptoms

Early identification is critical because adolescents often minimize or conceal substance use.

Warning signs may include:

Declining grades or school attendance
Loss of interest in hobbies or activities
Mood changes, irritability, anxiety, or depression
Changes in sleep or appetite
Secretive behavior or new peer groups
Declining personal hygiene
Family conflict or disciplinary problems
Physical signs such as the smell of alcohol or cannabis, bloodshot eyes, frequent intoxication, or unexplained injuries.

These symptoms are not specific to SUD but should prompt further assessment.

When Should Families Seek Help?

Parents and caregivers should contact their child's PCP if they notice:

Repeated intoxication or substance use
Declining school performance
Using substances to cope with stress or emotions
Stealing medications or alcohol
Continued use despite negative consequences
Withdrawal from family or previously enjoyed activities

Any child or adolescent who is difficult to awaken, has trouble breathing, experiences seizures, or is suspected of overdosing requires immediate emergency medical care by calling 911.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Many PCPs use the SBIRT model:

Screening identifies risky substance use before serious consequences develop.
Brief Intervention uses motivational interviewing to encourage healthier behaviors and increase readiness for change.
Referral to Treatment connects youth with behavioral health or addiction specialists when additional care is needed.

Confidential conversations are an important part of adolescent care. Explaining the limits of confidentiality while encouraging family involvement helps build trust and increases the likelihood that youth will disclose substance use honestly.

The American Academy of Pediatrics recommends routine substance use screening during annual adolescent preventive visits using validated screening tools such as:

Treatment

Treatment should be individualized and based on the severity of symptoms rather than the specific substance being used.

Evidence-based treatment may include:

Family-based therapy
Cognitive Behavioral Therapy (CBT)
Motivational Interviewing (MI)
Contingency Management
School-based supports
Treatment of co-occurring mental health conditions

For some adolescents, medications may also be appropriate, particularly for opioid use disorder, nicotine dependence, or certain alcohol use disorders when combined with behavioral treatment.

Note to Susan: Add promo blurb + link to SUD Screening Guide here

Recovery should be viewed as a long-term process. Like other chronic medical conditions, relapse may occur and should be addressed with continued support rather than viewed as treatment failure.

The American Society of Addiction Medicine (ASAM) Criteria can help clinicians determine the most appropriate level of care based on a comprehensive assessment of each patient's needs. Additional information, including guidance for adolescents and transition-aged youth, is available through the ASAM Criteria here: https://www.asam.org/asam-criteria. Nevada clinicians may also consult with NV PAL (for free) to help determine optimal treatment options for their patients.

Harm Reduction and Overdose Prevention

Even when a young person is not ready to stop using substances, steps can be taken to reduce the risk of serious harm.

Families and providers should discuss:

Safe storage of prescription medications, alcohol, cannabis products, and firearms
Proper disposal of unused medications
The availability and use of naloxone for opioid overdose
Avoiding use of substances alone
The dangers of mixing substances

It’s also important to note that illicitly manufactured fentanyl is increasingly found in counterfeit pills designed to resemble prescription medications such as oxycodone, Xanax®, and Adderall®. Adolescents may unknowingly consume fentanyl, substantially increasing the risk of overdose. See the U.S. Drug Enforcement Administration One Pill Can Kill initiative for more information: https://www.dea.gov/onepill.

Reducing Stigma and Supporting Recovery

Substance Use Disorder is a medical condition—not a moral failing or lack of willpower. Compassionate, evidence-based care improves outcomes and helps reduce stigma for children, adolescents, and their families.

With early identification, family engagement, and access to effective treatment, many adolescents recover successfully and go on to lead healthy, productive lives.

Key Takeaways for PCPs

Routine screening, early intervention, and family engagement can significantly reduce the long-term impact of Substance Use Disorder in children and adolescents. By using validated screening tools, assessing for co-occurring mental health conditions, implementing SBIRT, educating families about prevention and harm reduction, and connecting youth with evidence-based treatment, Nevada primary care providers can play a central role in improving outcomes and supporting recovery.

Nevada Resources

Nevada Pediatric Access Line (NV PAL)
https://nvpal.org

Provides behavioral health consultation, education, and referral resources for Nevada primary care providers caring for children and adolescents.

Nevada Division of Public and Behavioral Health
https://dpbh.nv.gov

Nevada 988 Suicide & Crisis Lifeline
Call or text 988
https://988lifeline.org

SAMHSA National Helpline
1-800-662-HELP (4357)
https://www.samhsa.gov/find-help/national-helpline

SAMHSA Behavioral Health Treatment Locator
https://findtreatment.gov

SUD Screening Guide

Pediatric Access Line