Prevent Substance Use at Every Age

Introduction

As a parent or someone in a parenting role, you are the biggest influence and the strongest intervention against your child/teen engaging in substance use at an early age. Your relationship with them guards against risk factors that your child/teen will encounter as they develop. It is through conversations with you that your child/teen will develop beliefs and understand your expectations about drugs and alcohol that will buffer them against information they receive in the media, from peers, and from other social interactions. It is important to talk with your child/teen early and often. How these conversations sound will change as your child matures.

Understanding how children/teens develop can help you successfully guide, shape, and support their growth. ¹ Research suggests when parents or those in a parenting role play an active part in their child’s/teen’s life, children/teens are less likely to experience problems managing stress or misusing substances later in life. ^{1, 2}

This document provides information about

• substance use and its impacts on brain development,
• child development at specific ages, and
• what parents and those in a parenting role can do at every age to prevent substance use.

Substance Use and the Developing Brain

Your child/teen is developing and changing in extraordinary ways. Your child’s/teen’s brain is going through significant structural and functional changes. The impact of substance use on the developing brain is significant and long-lasting. ³ Compared to adults, children/teens experience disproportionate harm from substance use. This is largely due to the stage of development of their brains and bodies.

Neurologically, there are two distinct parts of the brain that develop and mature at different times: the limbic system and the prefrontal cortex. The limbic system keeps us safe, is responsible for our fight/flight/freeze reactions, filters a lot of information, and houses our reward circuitry. We call this system the lizard brain. The lizard brain derives its understanding of the world from the past and does not do a good job thinking about the future or assessing the potential consequences of our actions. The limbic system is responsible for impulsivity, reward, and high emotion.

The limbic system develops and matures earlier than the prefrontal cortex, the part of the brain responsible for decision-making, judgment, and thinking through consequences. The prefrontal cortex, also called our wizard brain, helps us think through things, be creative, and manage our thoughts, feelings, and impulses. Because each part of the brain matures at different times, children/teens are more likely to engage in risky and impulsive behaviors like substance use and are more vulnerable to the rewarding or reinforcing effect of substance use than adults. Further, children/teens are more limited in their ability to accurately assess the risk of substance use as well as resist peer pressure. ⁴

Unfortunately, when children/teens consume drugs or alcohol, these substances start to alter the way the brain functions and how neurons operate. Ordinarily, the brain functions with ongoing communication between the limbic system and prefrontal cortex. When children/teens use drugs or alcohol, it over-activates the limbic system, the basal ganglia and amygdala in particular. These parts of the brain are responsible for motivation, pleasure, memory and reward. This leaves the limbic system as a rogue system prioritized over the frontal cortex. When this happens, thinking and judgment are impaired and the ability to regulate impulses is difficult. Over time, substance use over-activates the amygdala by sending signals of anxiety and irritability when the drug is not present and continued use is what provides some relief to this discomfort.

Child/teen substance use is associated with increased risk for delinquency, academic underachievement, teenage pregnancy, sexually transmitted diseases, perpetrating or experiencing violence, injuries, and mental health problems. Children/teens who use drugs or alcohol are more likely to also engage in risky sexual behaviors (not using a condom, multiple partners); experience violence, such as physical and sexual dating violence, and being bullied, threatened, or injured; and, be at greater risk for mental health problems and suicide. ^{5, 6} Given that the prefrontal cortex is not fully mature until the early to mid-20s, delaying use at least until then gives the brain the best chance at full development. Further, delaying or preventing use not only reduces the direct negative impacts of substances, it also reduces problematic outcomes that extend into adulthood.

Child Development at Specific Ages

As your child/teen ages, their physical, cognitive, social, and emotional needs develop and change. This means that as a parent or one in a parenting role, you are continually adapting your skills to meet the changing needs of your child/teen.

Your role in shaping your child’s/teen’s development will evolve as your child/teen matures. The ways you support an infant are different from the ways you support a teen. Adjusting your responses to meet your child’s/teen’s needs at each stage of development is important. For example, there are certain transition times in every child’s/teen’s life when they are more vulnerable to risk factors. Examples of such transitions include

• going to a new school,
• divorce,
• puberty, and
• birth of a new sibling.

Helping your child/teen adapt to these changes can decrease their risk of future problems. Added risk factors in the child’s/teen’s environment can negatively influence child development. These risk factors include

• lack of structure,
• stress,
• secondhand smoke, and
• parental neglect. ⁷

When preventing future substance use is a goal, there are ways you can support healthy childhood development based on your child’s age. Knowing what to look for at specific ages and knowing how best to support their growth during these times is important.

Ages 0-4

Children between the ages of 0-4 are experiencing many rapid changes. Infants and children are learning about themselves, their strengths and limitations, why they feel the way they do, and how they relate to others. Much of an infant’s/child’s learning is based on creating safe, stable, nurturing relationships and environments. ⁸ Positive relationships and environments are responsive, loving, dependable, and children feel supported and nurtured within them. ⁸ Infants/children come to better understand themselves by interacting with you.

Setting the Foundation for Healthy Choices With Children Ages 0-4

You can create safe, stable, and nurturing relationships and environments by responding to and meeting your child’s physical, social, and emotional needs. Being responsive to your child’s cries and needs and showing them love and caring is critical to building a child’s confidence to explore and interact with their world. You are your child’s biggest role model, so model positive behavior. A warm nurturing relationship with your child serves as a key protective factor against substance use as they grow up.

Actions

• Attend to your child’s needs.
  • Make dedicated time in your routine to be fully present with your child.
  • Recognize your infant’s cues (facial expressions, movements, and sounds) and respond to their cues. For example, if they are rubbing their eyes and yawning, offer to rock or cuddle and then put them down for a nap. If they are cooing or laughing, respond positively, smile, talk, and laugh with them.
  • Make time to hold your child. Children need physical contact. Rocking your child before bed or holding your child during story time are great opportunities for connection.
• Engage your child in interactions with you.
  • Your child learns and explores their world through play. They are eager to engage in imaginative play and, at times, cooperative play with others. Follow your child’s lead and play together.
  • Read books or chant rhymes together. Involve your child by letting them pick the book, hold the book, or turn the pages.
  • Make music and sing songs. Offer your child a simple instrument, like a rattle or tambourine, to play along.
  • Talk to your child. Narrate what you are doing. For example, you could say, “I am getting your breakfast ready and then we will eat.” Involve your child by asking questions such as, “Would you like blueberries or a banana this morning?”
• Set the stage for health.
  • Talk about the importance of taking care of our bodies – eating healthy, exercising, getting plenty of rest, brushing our teeth, bathing, etc. ⁹
  • If your young child watches you take a prescribed medication or is curious about a medicine bottle, talk to them about only taking medicines that have their name on them or that the doctor has given just for them. ⁹ You could say, “This is mommy’s medicine. The doctor gave it only for me to take. It is important to never take someone else’s medicine because it could make you sick.”
• Keep their environment safe.
  • Store alcohol out of your child’s reach and in a location that is not routinely accessed by your child.
  • Keep prescription drugs in a safe and secure place where your child won’t have access to them. And make sure to dispose of medications that have expired or that are no longer being used. ⁹
  • Keep dangerous substances found in your home like bleach, kitchen/bathroom cleaners, etc. out of your child’s reach, but also talk about these dangerous substances and explain why they can be harmful. ⁹ You could say, “You don’t want to touch this because it can burn your skin and your eyes.” Or, “This is dangerous because it can make you sick if you put it in your mouth.”

Ages 5-10

Children between the ages of 5-10 are active, excited to learn new skills and try new activities, and like to spend more time with their friends. Between the ages of 5-10, a child’s social development is an important focus. Much of a child’s learning through this phase is based on interactions with others in their environment.

As a parent or someone in a parenting role, promoting your child’s social growth and supporting their independence are essential. This teaches key social and emotional skills like self-awareness and self-regulation. Intellectually, your child is learning the idea of “self” and how to express empathy and relate to others. Your child develops a sense of empathy for others by experiencing it from you. If a child does not experience a nurturing relationship, stress hormones rise and negatively impact brain development. ¹⁰

The developing brain needs a non-threatening and predictable environment. Without a nurturing environment, a child develops a hyperactive stress response that leads to lowered immunity and increased likelihood of disease later in life. ¹¹ The ability to understand the difference between what is right and what is wrong is developed at this age and forms the backbone for healthy decision making in the future.

Addressing Substance Use With Children Ages 5-10

Having adults who model positive behavior is critical for children ages 5-10. Consider sports or different activities during these ages to build self-confidence and to engage in positive environmental influences that help support individual growth, autonomy, and their sense of independence.

Actions

• Be involved.
  • Your child will look for answers to their questions anywhere, so work hard to be the person they turn to for information.
  • Get to know your child’s friends and their parents.
• Capitalize on teachable moments.
  • Stay alert to any teachable moment (i.e., at the grocery store, while watching TV or listening to music, or talking about school).
  • If your child asks, answer questions about drug or alcohol use. Remember, it’s okay to not know the answer to a question. Let them know you will find the answer and follow up.
  • Don’t exaggerate the truth; stick with the facts.
• Be clear and consistent.
  • Starting at age 8, talking often and consistently about your clear rules and expectations about no alcohol use until after 21 is critical. It’s not a one time “big talk;” it’s frequent conversations.
• Help your child stay safe.
  • Give your child permission to leave situations that make them feel unsafe. ⁹ You could say, “If you are with your friends and you get into a situation that makes you feel unsafe, you don’t need to stay there. Call/text me and I will pick you up.”
  • Create a code word that lets you know they need you to help them leave an unhealthy situation. For example, you could decide that if your child ever texts you or calls you asking “How is Grandpa?” they need to be picked up.

Ages 11-14

Pre-adolescent development is a critical stage consisting of rapid physical and mental growth. The hormonal imbalances during ages 11-14 may cause some emotional distress for pre-teens. Intellectually, children/teens ages 11-14 tend to think in concrete ways and have difficulty with the abstract. The front part of their brain is not completely developed at this age, which means their emotional system (also called the limbic system) is running the show. Therefore, children/teens this age can be highly self-conscious, self-centered, dramatic, and some may be involved in higher risk behaviors such as consuming alcohol without fully thinking through the consequences.

Socially and emotionally, children/teens of this age may experience more drastic mood swings and be motivated to assert their independence, which may cause conflict. The development of social and emotional skills is critical at this age to help reduce the risk of using substances.

Addressing Substance Use With Ages 11-14

Children/teens ages 11-14 are experiencing physical changes. Acknowledging with your child the physical body changes they are experiencing is essential because some of these physical changes may be discomforting. Furthermore, understanding that at this age your child/teen is not skilled at managing their emotions can help you understand what tools and skills are important for building your child’s/teen’s ability to control their actions. Supporting your child’s/teen’s emotional development reduces the chances of your child/teen turning to unhealthy coping strategies such as alcohol use.

You can enhance the relationship you have with your child/teen by setting guidelines together which gives your child/teen more authority over their own decision making as they show responsibility and good choices.

Actions

• Be curious and learn what your child/teen knows.
  • Engage in conversations with your child/teen about substances. Share the science with your child/teen about how substances negatively impact the growing adolescent brain. Seek their opinion and be open to their views.
  • Encourage your child/teen to question the accuracy of information they hear about substances so they can make healthy choices. You could say, “When I hear something about substances, I use questions to help me understand if what I am hearing is accurate or misleading. I use questions like: “Where does this information come from?” “Why are they telling me this?” and “How do I know it is accurate? Let’s try to answer these questions using the information we just learned about cannabis* together.”
  • Model good listening skills. Good listening will increase the likelihood that your child/teen will talk to you about things that are of concern.
  • Even short conversations are helpful. Don’t worry about trying to cover everything in one interaction. The conversation will come around again, and you can seize the next opportunity.
  • Talk about things that may come up in their lives like other teens selling their prescription medication, classmates vaping at school, or being offered alcohol/drugs.
• Be involved and ask questions about where they are and what they are doing.
  • Ask your child/teen about their friends and get to know their friends.
  • When your child/teen goes out, be sure to have a plan for what they will do if offered drugs or alcohol, if they are uncomfortable and need to be picked up, and when they will be home.
  • Practice/role play with your child/teen about what to say if they are offered alcohol or other drugs. Offer plenty of suggestions for how to say “no” like: give a firm “no thanks,” change the subject, or say you have to get up early tomorrow for school, work, or practice. Also let them know they can always use you as an excuse and say: “No, my mom [or dad, aunt, etc.] would be really mad if I drink.” ⁹
  • Agree on a plan to check in when your child/teen is away. You could agree to text or call at certain times or when leaving or arriving at certain locations. You could say, “Please call/text me when you leave your friend’s house and head to the movies.”

*Cannabis is also called pot, weed, or marijuana

Ages 15-19

For teens between the ages of 15-19, the emotional/survival centers of the brain (also called the limbic or lizard brain) are well developed, but the thinking brain (also called the prefrontal cortex or the wizard brain) is still going through reorganization. During this stage of development, there can be physical and emotional discrepancies. While bodies mature quickly, emotional maturity and the ability to handle difficult situations may be lacking. It is during this stage that children/teens exercise their independence, separate from their parents or those in a parenting role, and spend most of their time in outside activities and with peers.
Addressing Substance Use With Ages 15-19

The influence of peers is strong, and therefore, teens need to learn how to recognize and manage peer pressure. Your teen needs your parental guidance because the standards you set will contribute to what they consider acceptable and in what they choose to take part. Taking an active role in your teen’s life at this stage of development is important so that you can be involved in discussions about important life decisions like drinking alcohol and other high-risk behaviors. ¹²

If appropriate, seek to involve older siblings and other positive role models in your teen’s life to influence positive decision making and build skills. Substance use has significant impacts on the teen brain and body, and teens are at higher risk of substance use because their peers are highly influential at this age. Substance use as a teen contributes to higher mortality rates and more progressive use of alcohol as they get older. ³

Actions

• Be curious and learn what your teen knows.
  • Engage in conversations with your teen about substances. Share the science with your teen about how substances negatively impact the growing adolescent brain. Seek their opinion and be open to their views.
  • Encourage your teen to question the accuracy of information they hear about substances so they can make healthy choices. You could say, “When I hear something about substances, I use questions to help me understand if what I am hearing is accurate or misleading. I use questions like: “Where does this information come from?” “Why are they telling me this?” and “How do I know it is accurate?”
  • Model good listening skills. Good listening will increase the likelihood that your teen will talk to you about things that are of concern.
  • Even short conversations are helpful. Don’t worry about trying to cover everything in one interaction. The conversation will come around again, and you can seize the next opportunity.
  • Continually reinforce structure and boundaries.
  • Be involved in your teen’s schedule and know where your teen is.
  • Have clear conversations about risky and harmful behavior such as drinking and driving. Your teen should have no question about where you stand or what the consequences of their actions will be if they engage in risky behaviors.
  • Discuss rules and expectations regularly; affirm when your teen meets the expectations and follow through with consequences as needed when your teen does not.
  • Get to know your teen’s friends and their parents.
• Keep talking about peer pressure and help your teen practice responding to it.
  • Help your teen develop skills to manage peer pressure.
  • Offer alternative behaviors that teens can engage in so that if they say no to drugs and alcohol, they have alternatives to say yes.
  • Have a code word that your teen can use in a text or phone call that lets you know they need you to help them leave an unhealthy situation. Let them know at the time their safety is the most important, no questions will be asked, and you will help them in any way you can. Ask them to include other family members or friends in this safety plan.
  • Have open conversations with your teen about drugs and alcohol and about peer pressure.
• Catch your teen doing it right and acknowledge how tough it is.
  • Encourage and affirm any positive behavior or positive decision making you see in your teen.
  • Avoid falling into the trap of thinking, “It’s what teens do; all teens use pot (or alcohol).” It is not what all teens do and has incredibly negative impacts on their brain and body.
  • Manage your own emotions as you talk with your teen, so you can have a calm and confident conversation with them.
• Pay attention. Your role is changing from manager to consultant. So, be available and consistent as the consultant.
  • Notice changes in your teen’s mood, sleeping patterns, school performance, and friends. These changes can serve as red flags that your teen might be engaged in substance use. If you notice changes, get curious. You could say, “I noticed you aren’t hanging around your normal group of friends. Is something going on with your usual friends?” “Tell me about your new friends. What are they like? What do they like to do? What do you like about them?” ⁹

For All Ages

We can also help our children/teens develop healthy attitudes about alcohol by modeling how we act. For example:

• Not over-consuming alcohol in front of them.
• Not asking them to serve alcohol or bartend at family events.
• Telling them how you manage yourself to drink responsibly (or why you choose not to drink) and what to do if someone else is not.
• Being honest about your own use (although be careful not to use your past experiences as “horror stories” as this sharing can inadvertently reinforce the undesired behavior)..
• Being aware of the facts about how alcohol affects children/teens differently than adults.
• Not hosting drinking parties or buying alcohol for your child/teen and their friends.
• Not regularly taking your child/teen to an establishment that solely serves adult beverages. Consider hiring a qualified babysitter while you enjoy your adult time.
• Never drinking and driving and not riding in a car with someone who has been drinking.

Closing

Parents and those in a parenting role are the strongest intervention to guard against risk factors that their child/teen will encounter as they develop including the use of substances. Guiding and supporting your child/teen in each stage of their development requires adjusting your responses and adapting your skills to meet the changing needs of your child/teen.