Substance use during adolescence is linked to adverse health outcomes, including mental health problems, sexually transmitted diseases, and teen pregnancy. Substance use initiation during adolescence can also increase the risk of substance use disorders and consequences such as poor relationships, violence, and academic challenges. While recent data indicates substance abuse amongst teens and adolescents has been declining or remained stable for the past several years, there has been an increase in alcohol-related deaths and a striking rise in overdose deaths among young people ages 14-18. School nurses, as health educators, care providers, and public health liaisons, have the knowledge, skills, and relationships to make a real difference in the fight against youth substance abuse. 

Understanding Risk Factors

During adolescence, young people explore their identity and independence, and their still-developing brains have limited decision-making and behavior-control abilities. These cognitive traits, combined with other potential risk factors, including a family history of addiction, childhood maltreatment, poor self-image, low religiosity, poor school performance, family dysfunction, and exposure to peer pressure, can increase the likelihood of substance use and abuse.

Furthermore, mental health plays a significant role, with substance use disorders occurring in almost half of students with mental health disorders, particularly if left untreated. Students with ADHD or ODD are two to three times more likely to abuse substances due to their biological susceptibility to experiencing more intense effects from drugs and alcohol. Similarly, students who are anxious or depressed may find temporary relief from their symptoms by “self-medicating” with substances, potentially leading to misuse and abuse. At the same time, substance use may lead to changes in brain structure and function, resulting in the development of mental health disorders.

Implementing Strategies

Prevention and improvement approaches to substance misuse are most effective in schools when done collaboratively with parents and other community resources. Programs implemented in childhood and adolescence that boost protective factors while lessening the impact of risks effectively reduce substance abuse and promote long-lasting positive health behaviors into adulthood.

• Identification - Early recognition of students who may be at risk for alcohol or substance misuse or abuse is essential to prevention. Signs may include extreme mood swings, dramatic changes in academic performance, disregard for school rules, behavior concerns, or social isolation or turmoil. Schools should develop protocols for school nurses to follow in assessing students suspected to be under the influence of drugs or alcohol, including a policy around emergency administration of Naloxone.

• Education - In 2017, more than one in four students aged 12 to 17 who were enrolled in school in the past year reported not having seen or heard drug or alcohol use prevention messages at school. According to the National Institute on Drug Abuse (NIDA), education is most successful when it begins in elementary school, between the ages of 9 and 12. Lessons should be interactive, accurate, and relevant to real life, focusing on the substances most prevalent in the community - most often alcohol, opioids, tobacco, and cannabis. Education that is provided lecture-style, not linked to the curriculum, stigmatizes, or uses scare tactics is ineffective. Recommended resources for drug use prevention include Brain Power and National Institute of Health Lesson Plans and Activities.

• Outreach - Building a safe school environment promotes open and healthy discussions, and where support from school professionals, including teachers, counselors, and nurses, is accessible is vital to substance abuse and misuse improvement and prevention. Information should be made readily available to students and parents in various formats, including newsletters, bulletin boards, and health promotion events. Resources for those needing additional support or treatment are important to have on hand for guidance and referral.

Substance abuse can occur at any age, but young people and adolescents are particularly at risk. No single factor determines whether a student will misuse or abuse substances; instead, it is a multifaceted issue that requires a collaborative community approach. Schools can make a tremendous impact by modifying risk and preventative factors and implementing preventative policies and programs.