Other Risk Behaviors

As adolescents begin individuation from their parents and become increasingly concerned about peer acceptance, they are especially vulnerable for engaging in risky behaviors. In the sections above, we have discussed concepts related to sexual behaviors. In this section, we will add key concepts related to substance use and eating disorders

Substance Use

More info: stages of drug use

Stage 1- experimentation

Use is in social settings and is often the result of peer pressure. The substance comes from friends. The user is often inept and injury can occur from overdosage or accidents. Outside the consequences of getting caught, usage does not affect family life and school performance. Most providers treat information shared by teens at this stage confidentially and provide counseling.

 Stage 2- actively seeking

The adolescent in this stage are seeking the effect of the substance. They often maintain their own stash and use may occur in non-social contexts. The teen may get "high" to reduce test stress instead of studying or to cope with psychosocial issues. Use begins to affect family life and school performance. Teens in this stage need to be followed closely and helped with issues related to use. Once aware of the problem, the physician may need to enlist the aid of parents to intervene if the minor teen does not abstain on their own.

 Stage 3- preoccupation 

This is the classic "drug addict." The teen's entire life revolves around the issue of obtaining substances and getting "high." Use is compulsive, even in the face of problems with the family, school and the law. Often they are into poly-drug use. The quantity of drugs used may be expensive and lead to criminal activity such as drug trafficking, theft or prostitution. Teens in this stage should be referred to experts in the field as treatment is complicated and the users are often devious.

 Stage 4- burnout

This stage is rarely seen in teens as it usually takes years of use to cause enough damage. Some substances are more neurotoxic and can lead quickly to this stage (e.g., inhaling carburetor cleaning fluid). Substances are used to prevent the negative effects of withdrawal or just to feel normal. Often the teen has no family or work life left. Even when off the substances, most people will identify these individual as abnormal because of their flattened affect, sluggish processing and slowed speech. Again, these individuals should be cared for by experts in the field.

Alcohol, nicotine (cigarettes or chewing tobacco) and marijuana are the substances used most commonly by teens. Other drugs are used by less than 10% of the adolescent population. Drug use can be divided into phases: experimentation, active seeking, preoccupation, and burn out. Determining the stage or pattern of use can help the provider determine what additional intervention is appropriate.

Signs of possible substance abuse

Parents are often the first to be concerned as the teen withdraws from family activities or begins flouting family rules. Declining grades, truancy and withdrawal from extracurricular activities are other signs of drug use. Some medical conditions may become exaggerated, such as asthma from smoking marijuana. Dysphoria, confusion, irritability and low tolerance of frustration may occur along with self-destructive behaviors. Stealing and other criminal behaviors may get the teenager in trouble with the law.


A good history and physical exam are the most sensitive tools for diagnosing substance use. Substance users are often seductive liars, making it is important to corroborate the history with a family member. Parents are usually unaware of the specifics of use but can detail associated behaviors such as truancy or changes in behavior.

Drug testing is specific but not very sensitive and does not reveal the pattern of use. A positive test for marijuana does not discern the teen who smoked it once from the one who smokes seven times a day.


The pattern of use determines the treatment. When caught, teens try many different ploys. It is best to warn the parents beforehand. Common statements from teens include, "You don't really think I would use that stuff do you," "Someone put it in my drink," "I was holding it for a friend," "It was second hand smoke," and "Everyone else does it." Parent reactions vary from denial, outrage aimed at the physician, sadness, guilt and fear. Substance use may be a chronic problem requiring long term follow up with periods of exacerbation and improvement.