Substance Use and the Teenage Mind: A New Look at Treating Adolescents in Therapy

substance abuse and the teenage mindAdolescence arrives with a surge of emotional energy.  It can empower youth to expand their capabilities, make new friends, depend less on parents, and live more passionately.  The influence of parents remains important in a child’s life, and is necessary to support teens in making good choices.

Adolescence is also a time when some teens look to experience alcohol or drugs (such as heroine, cocaine, marijuana and prescription medicine, among other substances). All too often, tragic results follow.

As therapists, how can we help more teens and families avoid or repair the damage and danger of substance abuse?  What can we know about adolescent development to better understand the needs, risk factors and vulnerabilities at this life stage, and respond effectively?

Adolescence Spans More Years Than Most People Realize

Adolescence starts at about age 11 in girls, 12 1/2 in boys, and continues into a person’s mid-twenties. Neuroscience tells us that the brain changes dramatically during this time and does not fully develop until age 27.

Brain remodeling refers to the process of physical and neurological transformation. Excess neurons that formed during childhood die off naturally — a process of synaptic pruning.  A performance-enhancing sheath (myelin) grows along the remaining active neurons — a change called myelination. The myelin sheath allows impulses to flow up to 3000 times faster along the brain’s circuits. The brain becomes more specialized, efficient and more integrated.

New Thoughts, Feelings and Vulnerabilities Emerge

We also know that new ways of thinking, feeling and behaving appear — sometimes dramatically — during this time. Four qualities emerge with adolescence: “Novelty seeking, social engagement, increased emotional intensity and creative exploration,” says Daniel Siegel in his book Brainstorm: The Power and Purpose of the Teenage Brain.

These qualities inspire many young people to do amazing and wonderful things. However, without the benefit of healthy attachments, these drives can also misguide others toward dangerous, high-risk, even deadly behavior.

How vulnerable are adolescents to risky and dangerous substance use behaviors?  The numbers are staggering.  While they do not predict the risk for any one person, they reveal unmet needs for education and appropriate guidance for adolescents:

  • One in five youth between the ages of 12 and 17 in the US have an abusive/dependent or problematic use of illicit drugs or alcohol
  • Alcohol poisoning and related incidents cause 4,358 deaths each year for youth under age 21, and lead to emergency-room injuries for another 190,000 people in this age group each year (NIAA, Underage Drinking)
  • Over 27% of 8th, 10th and 12th graders in the US report past-year use of an illicit drug other than alcohol (NIDA DrugFacts, December 2014)
  • After marijuana, prescription and over the counter medications account for most illegal drug use by 12th graders in 2013
  • Underage drinking accounts for 11% of all alcohol consumed in the US, 90% of which is consumed in binge drinking (CDC Fact Sheets – Underage Drinking)
  • Youth who drink or use drugs are more likely to become victims of sexual or physical assault
  • The average onset of first use of drugs or alcohol for boys is 12, for girls it is 12 1/2
  • For those who began consuming alcohol by age 15, 47% experienced alcohol dependence later in life, compared to 9% who began at age 21 or older (NCADD FAQ)

Adolescents make decisions, choose behavior and experience consequences differently than adults do. It can be very perplexing for adults to look on and try to make sense of a young person’s journey.

Substance Use and the Teenage Mind: A New Look at Treating Adolescents in Therapy

Robyn Brickel, MA, LMFT

Robyn E. Brickel MA, LMFT, is the founder and director of Brickel and Associates, LLC in Old Town Alexandria, Virginia, which she established in 1999. Her insights for parent and teens appear in interviews in The Washington Post, and Washington Parent magazine, and she presents educational workshops for clinicians on the treatment of adolescent substance abuse and trauma. Her counseling and psychoeducational services provide treatment for recovery from trauma and/or abuse, including dissociation; addictions; adult children of alcoholics (ACOA) issues; body image issues and eating disorders; self-harming behaviors, including emotional intensity and instability; anxiety, depression, and other mood disorders; challenged family systems; chronic illness; co-dependency; dysfunctional relationships; life transitions; loss and bereavement; relationship distress; self esteem; GLBTQ and sexual identity issues/struggles; and stress reduction. She is a trained trauma and addictions therapist who has helped countless clients make and maintain positive changes in their lives. To learn more about Robyn E. Brickel, visit her website.


APA Reference
Brickel, R. (2016). Substance Use and the Teenage Mind: A New Look at Treating Adolescents in Therapy. Psych Central. Retrieved on August 13, 2020, from


Scientifically Reviewed
Last updated: 2 May 2016
Last reviewed: By John M. Grohol, Psy.D. on 2 May 2016
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