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How Dependence on Alcohol and Drugs Develops

Teen substance use can progress, sometimes rapidly, from experimenting or occasional use to misuse and dependence (addiction).


Teens try alcohol, cigarettes, chemicals (inhalants), and other drugs for many of the same reasons that adults use them, to relax or feel good. But they also have other reasons for drug use, such as curiosity, rebellion against their parents, or seeking acceptance from their peers.

Often the first substance used by a teen is alcohol or cigarettes, and many times these are obtained from the teen's own home. Some parents expect and tolerate experimentation with these substances because at least the teen is not using "drugs." But these substances are considered gateway drugs, because they can lead to the use of other drugs.

Most teens never go any further than experimenting with substance use. But if experimentation begins before the age of 15, a teen is likely to continue and to develop problems related to use. Other things that make a teen likely to develop a substance use problem include:

  • Using a substance alone rather than in a peer group.
  • Having untreated behavioral problems or psychiatric conditions.

Regular use

At this stage, teens frequently seek opportunities to use the chosen substance or substances. Also, a teen may start to need more and more of the substance to achieve the same effect: this is called tolerance.

Often the first signs of substance use are school problems, such as a sudden increase in absences or falling grades. The teen may also have problems at home, including conflicts with parents. Teens often give up activities that they enjoy in order to use the substance. Also, teens may use the substance in school or in situations that lead to legal problems. They may sell drugs as well as use them.

Substance use needs treatment to prevent the progression to dependence (addiction). Over half of teens who use drugs or alcohol eventually become addicted. Although treatment for substance dependence can be effective, it is best to intervene before dependence develops.


Substance dependence (addiction) is physical or psychological or both. It results in increased tolerance and in withdrawal symptoms if the dependent person stops using the substance.

As your teen progresses toward dependence, he or she experiences increasing difficulty carrying out normal daily responsibilities and routines. Getting and using the substance may take up a large portion of the teen's activities, regardless of the consequences. Over time, tolerance increases, and the teen loses control over use of the substance.

At this stage, your teen's physical appearance or health may change or get worse. These changes may include weight loss, dental or gum disease, or complexion problems. Your teen may show less interest in personal hygiene or clothing. Lying about alcohol and drug use is common. And the teen often becomes isolated from family and friends. Since abusing drugs can be expensive, the teen may steal from family members or sell drugs to support his or her habit. Your teen may even stop using the substance for 2 to 3 weeks at a time, creating the false belief that his or her use is under control.

Substance dependence is a lifelong (chronic) disease, which can be controlled with the help of professional treatment. Returning to use after treatment (relapse) is common. And treatment may have to be repeated several times. Usually a long-term support system is needed for the teen to maintain a lifestyle that does not include substance use.

ByHealthwise Staff
Primary Medical ReviewerPatrice Burgess, MD - Family Medicine
Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerPeter Monti, PhD - Alcohol and Addiction
Christine R. Maldonado, PhD - Behavioral Health

Current as ofOctober 9, 2017

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