What is a Substance Use Disorder in Children?
Substance use disorder (SUD) in pediatrics refers to symptoms in which a child or adolescent continues using a substance despite significant substance-related problems, as defined by the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). It is now understood as a chronic medical condition and often seen by pediatricians who care for children in Missouri.
The diagnostic criteria include 11 maladaptive behaviors and symptoms in the areas of social problems, loss of control, risky behaviors, and physiological changes — occurring within the past 12 months. Severity of substance use disorders are as follows:
– Mild: 2–3 criteria
– Moderate: 4–5 criteria
– Severe: ≥6 criteria
The DSM-5 criteria were developed for adults and may not capture specific patterns of substance use in children.
The most common substance use disorders in children and teens involve alcohol and cannabis.
What are the Risk Factors for Developing a Substance Use Disorder?
– Individual-level: Genetic predisposition, positive attitude toward substance use, early onset of substance use
– Environmental: Family dysfunction, parental substance use disorder, peer substance use, substance availability, involvement in the juvenile justice system
– Stressful early-life environments
How Do I Know If My Child Has a Substance Use Disorder?
The American Academy of Pediatrics recommends screening for substance use at well child visits. Your physician may use the S2BI (Screening to Brief Intervention) and/or BSTAD (Brief Screener for Tobacco, Alcohol, and Drugs) the well child visit.
What is the Treatment for Substance Use Disorder in Children?
According to the 2025 American Academy of Chid and Adolescent Psychiatry Clinical Practice Guideline, suggested treatments for adolescent SUD include:
– Brief (1–2 session) motivational interviewing for alcohol use
– Non-brief (>2 sessions) motivational interviewing, family therapy, or cognitive behavioral therapy for alcohol use disorder with or without other drug use
– Motivational interviewing plus CBT for illicit drug disorders
– Longer-term buprenorphine treatment (with slower taper) for opioid use disorder
What are the Side Effects of the Medications Used to Treat Substance Use Disorder?
The medications to treat substance use disorder in children are limited. Buprenorphine is the only FDA-approved medication for adolescents (≥16 years) for opioid use disorder. Below is a summary of adverse effects of buprenorphine.
Buprenorphine (partial μ-opioid agonist; FDA-approved ≥16 years) — Common adverse effects include sedation, headache, and constipation. Additional opioid-class effects include nausea, sweating, and itching. Some adolescents may require lower doses due to shorter use histories, and doses can be adjusted to reduce side effects.
Next Steps
If you’re concerned your teen may be struggling with substance use disorder, early support can make a meaningful difference. Don’t wait for the problem to worsen—reach out to a qualified mental health or addiction professional to learn about treatment options, family support, and next steps toward recovery. Help is available, and recovery is possible.
Discussion Questions:
What warning signs of substance use disorder in teens do you think are most often overlooked by parents or caregivers?
How can communities work together to better support teens struggling with substance use?
What steps can parents take to create open, judgment-free conversations about substance use with their teenagers?
MEDICAL DISCLAIMER
Medical Emergency Notice: Do NOT use this document for medical emergencies. If you have a medical emergency, call a physician or qualified healthcare provider, or CALL 911 immediately. Under no circumstances should you attempt self-treatment based on anything you have seen or read in this document.
General Information is Not Medical Advice: The general information provided in this document is for informational purposes only and is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute. Always seek the advice of your physician or other qualified health provider concerning any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this document.