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ABCD: Understanding the Risks of Substance Use Disorder

ABCD: Understanding the Risks of Substance Use Disorder

When our son, then 18, went to inpatient treatment for his substance use disorder, my husband and I were relieved that he was finally going to get the help we knew he’d needed for a long time. We had first suspected there was a problem in high school when we would find marijuana paraphernalia and rolling papers in his jeans pockets when we were doing the laundry. Curfews were routinely broken; twice, the police were involved.

I even called treatment centers when he was 17 asking if they admitted people for marijuana addiction but was told that according to the current Diagnostic and Statistic Manual of Mental Disorders, the book that health insurers use to set reimbursement rules, marijuana was not considered a physically addictive substance. Unless he was also addicted to another substance like alcohol, our son could be admitted but his insurance probably wouldn’t cover the $25,000-plus needed for a routine 28-day stay. I called three other treatment centers and was told the same thing. (As it turned out, my son was having a problem with alcohol but was heavily moderating it with marijuana, which further confounded a diagnosis as well as getting him into treatment.)


Fortunately, those rules have since changed and it has become easier to get help for substance use disorder, including marijuana. And that’s good because, according to the National Institute on Drug Abuse, nearly 10 percent of those who use marijuana will become dependent on it. That figure rises to 17 percent in those who start using the drug as teenagers. According to the most recent National Survey on Drug Use and Health, marijuana accounted for 4.2 million of the estimated 6.9 million Americans dependent on or abusing illicit drugs.

Given that this is such a widespread problem that affects so many families, it’s kind of incredible that parents don’t know more about the risk factors of developing substance use disorder, including marijuana addiction. Who is vulnerable? What can you do as a parent to protect your kids? Why are some young people at risk but others—even in the same family, like brothers or sisters—are more immune?

As a passionate advocate of improving access to services for young people in recovery, especially those involving housing, education and employment, I often find myself in conversation with other parents whose sons or daughters have been affected by substance use disorder or, heartbreakingly, those whose children lost the battle in their efforts against addiction. And I’m not shy when it comes to speaking openly about the problem: how else will things change if we don’t raise our voices together?

But some questions are always asked more urgently than the rest: Should I have known? Was there anything I could have said or done? Twelve-step programs like Al-Anon state that neither parents, nor anyone else, can “cause, cure or control” a substance use disorder. And I firmly believe that. But educating one’s self and one’s family about the risk factors of who is susceptible is a different story. There is still a lot that we can do, and that must be done, to inform and protect our young people.

I was at the dermatologist’s office recently getting an annual checkup. With a history of skin cancer in my family, I am vigilant about sunscreen and suspicious-looking moles. On the wall of the examining room was a large poster describing the warning signs of melanoma in an easy-to-follow way that even non-scientists could understand: A = asymmetrical shapes; B = borders that are irregular; C = colors other than a single shade of brown or tan; D = large diameter (anything bigger than a pencil eraser is bad). Simple, right? Suddenly, I was feeling much better about the tiny brown spot on my arm. The doctor agreed it was just a freckle. But then I started thinking: if skin cancer has an easy ABCD guide to its warning signs, why doesn’t substance use disorder?




























So, I talked to a lot of experts and this is what I learned. There actually is a very simple ABCD way to discover whether your child or a loved one is at risk for developing substance use disorder and all parents—as well as professionals like doctors, teachers and coaches and others who work with adolescents and young adults—should know about it: A = age of first use; B = big life changes; C = co-existing mental/behavioral health conditions; D = DNA/family history.

Let’s start with “A,” age of first use. The younger you are when you first start regularly using drugs or alcohol, the more dangerous it is. According to the National Council on Alcoholism and Drug Dependence, kids who drink alcohol before age 15 are five times more likely to become alcoholics than those who first drink at age 21 or older. Additionally there are lasting effects of drugs/alcohol on developing brains.

“B,” big life changes can include anything that is traumatic or deeply unsettling to a young person such as the divorce, separation, or remarriage of a parent; the death of a loved one; the breakup of a romantic relationship; moving to a new school; the loss of a parent’s job or economic insecurity; being the victim of a crime; being abused or bullied.

“C,” co-existing mental or behavioral disorders, even if treated, have been linked to higher addiction rates in teens and young adults. These can include but are not limited to ADHD, anorexia/bulimia, autism spectrum disorders, bipolar disorder, depression and anxiety.

Finally, “D,” DNA or family history: this one is probably the most widely accepted and easily understood, given what we now know about the role of genetics and other mental and behavioral health disorders. Still, it is helpful to put this information in stark terms in case anyone somehow doubts it. Children of parents who suffer from substance use disorder are 400% more likely to develop it themselves than children of parents who do not have the condition. Studies of identical twins confirm the role of genetics. Odds are also increased if a grandparent, aunt, uncle, sibling or cousin has the condition.

So, fellow parents, talk to your adolescents and young adults about the risks of substance use disorder. Talk to each other. Tell your friends, neighbors, family members, the PTA, your school’s guidance counselor, your pediatrician and anyone else who will listen. We can do more to educate our communities about the risks of substance use disorder and who will develop it. With this knowledge, we can identify young people who might need help earlier and “inoculate” those who are vulnerable with better preventive supports like pro-social activities or counseling. While breaking the silence may feel awkward, it doesn’t have to be hard. In fact, it can be as easy as ABCD.

Ann Herbst is the development director of Young People in Recovery (YPR), a national nonprofit dedicated to improving access to education, housing and employment for young people in, or seeking, recovery from substance use disorder. To learn more about YPR or to find a chapter in your community, please visit or visit










Ann Herbst

Development Director

Young People in Recovery

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